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Busch HJ, Wolfrum S, Michels G, Baumgärtel M, Bodmann KF, Buerke M, Burst V, Enghard P, Ertl G, Fach WA, Hanses F, Heppner HJ, Hermes C, Janssens U, John S, Jung C, Karagiannidis C, Kiehl M, Kluge S, Koch A, Kochanek M, Korsten P, Lepper PM, Merkel M, Müller-Werdan U, Neukirchen M, Pfeil A, Riessen R, Rottbauer W, Schellong S, Scherg A, Sedding D, Singler K, Thieme M, Trautwein C, Willam C, Werdan K. [Clinical acute and emergency medicine curriculum-focus on internal medicine : Recommendations for advanced training in internal medicine in the emergency department]. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01113-3. [PMID: 38625382 DOI: 10.1007/s00063-024-01113-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 04/17/2024]
Abstract
In Germany, physicians qualify for emergency medicine by combining a specialty medical training-e.g. internal medicine-with advanced training in emergency medicine according to the statutes of the State Chambers of Physicians largely based upon the Guideline Regulations on Specialty Training of the German Medical Association. Internal medicine and their associated subspecialities represent an important column of emergency medicine. For the internal medicine aspects of emergency medicine, this curriculum presents an overview of knowledge, skills (competence levels I-III) as well as behaviours and attitudes allowing for the best treatment of patients. These include general aspects (structure and process quality, primary diagnostics and therapy as well as indication for subsequent treatment; resuscitation room management; diagnostics and monitoring; general therapeutic measures; hygiene measures; and pharmacotherapy) and also specific aspects concerning angiology, endocrinology, diabetology and metabolism, gastroenterology, geriatric medicine, hematology and oncology, infectiology, cardiology, nephrology, palliative care, pneumology, rheumatology and toxicology. Publications focussing on contents of advanced training are quoted in order to support this concept. The curriculum has primarily been written for internists for their advanced emergency training, but it may generally show practising emergency physicians the broad spectrum of internal medicine diseases or comorbidities presented by patients attending the emergency department.
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Affiliation(s)
- Hans-Jörg Busch
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Sebastian Wolfrum
- Interdisziplinäre Notaufnahme Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - Guido Michels
- Notfallzentrum, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Trier, Deutschland
| | - Matthias Baumgärtel
- Klinikum Nürnberg, Universitätsklinik für Innere Medizin 3 der Paracelsus Medizinischen Privatuniversität, Nürnberg, Deutschland
| | | | - Michael Buerke
- Medizinische Klinik II, St. Marien-Krankenhaus Siegen, Siegen, Deutschland
| | - Volker Burst
- Schwerpunkt Klinische Akut- und Notfallmedizin und Klinik II für Innere Medizin, Uniklinik Köln, Köln, Deutschland
| | - Philipp Enghard
- Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité Universitätsmedizin, Berlin, Deutschland
| | - Georg Ertl
- Deutsches Zentrum für Herzinsuffizienz, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Wolf Andreas Fach
- MVZ CCB am AGAPLESION Bethanien Krankenhaus, Frankfurt (Main), Deutschland
| | - Frank Hanses
- Interdisziplinäre Notaufnahme, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Hans Jürgen Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik, Klinikum Bayreuth - Medizincampus Oberfranken und Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth, Deutschland
| | | | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Stefan John
- Medizinische Klinik 8, Abteilung für Internistische Intensivmedizin, Klinikum Nürnberg-Süd, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - Christian Jung
- Klinik für Kardiologie, Pneumologie und Angiologie des Universitätsklinikums Düsseldorf, Heinrich-Heine Universität Düsseldorf, Düsseldorf, Deutschland
| | - Christian Karagiannidis
- ARDS und ECMO Zentrum Köln-Merheim, Kliniken Köln und Universität Witten/Herdecke, Köln, Deutschland
| | - Michael Kiehl
- Medizinische Klinik I, Klinikum Frankfurt (Oder), Frankfurt (Oder), Deutschland
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Alexander Koch
- Medizinische Klinik III, Universitätsklinikum Aachen, Aachen, Deutschland
| | | | - Peter Korsten
- Klinik für Rheumatologie und Klinische Immunologie, St. Josef-Stift Sendenhorst, Sendenhorst, Deutschland
| | - Philipp M Lepper
- Klinik für Akut- und Notfallmedizin, Universität und Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | | | - Ursula Müller-Werdan
- Medizinische Klinik für Geriatrie und Altersmedizin, der Charité - Universitätsmedizin Berlin und EGZB, Berlin, Deutschland
| | - Martin Neukirchen
- Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Alexander Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena, Deutschland
| | - Reimer Riessen
- Internistische Intensivstation 93, Dept. f. Innere Medizin, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Wolfgang Rottbauer
- Klinik für Innere Medizin II (Kardiologie, Angiologie, Pneumologie, Intensivmedizin, Sport- und Rehabilitationsmedizin), Universitätsklinikum Ulm, Ulm, Deutschland
| | | | | | - Daniel Sedding
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06097, Halle (Saale), Deutschland
| | - Katrin Singler
- Universitätsklinik für Innere Medizin - Geriatrie & Institut für Biomedizin des Alterns, Klinikum Nürnberg Paracelsus Medizinische Privatuniversität & Friedrich-Alexander Universität Erlangen-Nürnberg, Nürnberg & Erlangen, Deutschland
| | - Marcus Thieme
- Abteilung Innere Medizin und REGIOMED Gefäßzentrum, REGIOMED Klinikum Sonneberg, Sonneberg und Klinik für Innere Medizin I, Universitätsklinikum Jena, Jena, Deutschland
| | | | - Carsten Willam
- Medizinische Klinik 4, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Karl Werdan
- Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Ernst-Grube-Straße 40, 06097, Halle (Saale), Deutschland.
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Kochlik B, Herpich C, Moreno-Villanueva M, Klaus S, Müller-Werdan U, Weinberger B, Fiegl S, Toussaint O, Debacq-Chainiaux F, Schön C, Bernhard J, Breusing N, Gonos ES, Franceschi C, Capri M, Sikora E, Hervonen A, Hurme M, Slagboom PE, Dollé MET, Jansen E, Grune T, Bürkle A, Norman K. Associations of circulating GDF15 with combined cognitive frailty and depression in older adults of the MARK-AGE study. GeroScience 2024; 46:1657-1669. [PMID: 37715843 PMCID: PMC10828354 DOI: 10.1007/s11357-023-00902-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/31/2023] [Indexed: 09/18/2023] Open
Abstract
Growth differentiation factor-15 (GDF15) might be involved in the development of cognitive frailty and depression. Therefore, we evaluated cross-sectional associations of plasma GDF15 with combined cognitive-frailty-and-depression in older (i.e. ≥ 55 years) and younger adults of the MARK-AGE study. In the present work, samples and data of MARK-AGE ("European study to establish bioMARKers of human AGEing") participants (N = 2736) were analyzed. Cognitive frailty was determined by the global cognitive functioning score (GCF) and depression by the Self-Rating Depression Scale (SDS score). Adults were classified into three groups: (I) neither-cognitive-frailty-nor-depression, (II) either-cognitive-frailty-or-depression or (III) both-cognitive-frailty-and-depression. Cross-sectional associations were determined by unadjusted and by age, BMI, sex, comorbidities and hsCRP-adjusted linear and logistic regression analyses. Cognitive frailty, depression, age and GDF15 were significantly related within the whole study sample. High GDF15 levels were significantly associated with both-cognitive-frailty-and-depression (adjusted β = 0.177 [0.044 - 0.310], p = 0.009), and with low GCF scores and high SDS scores. High GDF15 concentrations and quartiles were significantly associated with higher odds to have both-cognitive-frailty-and-depression (adjusted odds ratio = 2.353 [1.267 - 4.372], p = 0.007; and adjusted odds ratio = 1.414 [1.025 - 1.951], p = 0.035, respectively) independent of age, BMI, sex, comorbidities and hsCRP. These associations remained significant when evaluating older adults. We conclude that plasma GDF15 concentrations are significantly associated with combined cognitive-frailty-and-depression status and, with cognitive frailty and depressive symptoms separately in old as well as young community-dwelling adults.
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Affiliation(s)
- Bastian Kochlik
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- Food4Future (F4F), c/o Leibniz Institute of Vegetable and Ornamental Crops (IGZ), Theodor-Echtermeyer-Weg 1, 14979, Grossbeeren, Germany
| | - Catrin Herpich
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam , Potsdam, Germany
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - María Moreno-Villanueva
- Molecular Toxicology Group, Department of Biology, University of Konstanz, Constance, Germany
- Human Performance Research Centre, Department of Sport Science, University of Konstanz, Constance, Germany
| | - Susanne Klaus
- Institute of Nutritional Science, University of Potsdam , Potsdam, Germany
- Department of Physiology of Energy Metabolism, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Ursula Müller-Werdan
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Protestant Geriatric Center Berlin (EGZB), Berlin, Germany
| | - Birgit Weinberger
- Research Institute for Biomedical Aging Research, Universität Innsbruck, Rennweg 10, 6020, Innsbruck, Austria
| | - Simone Fiegl
- UMIT TIROL, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - Olivier Toussaint
- URBC-Narilis, University of Namur, Rue de Bruxelles 61, B-5000, Namur, Belgium
| | | | | | - Jürgen Bernhard
- BioTeSys GmbH, Schelztorstraße 54-56, 73728, Esslingen, Germany
| | - Nicolle Breusing
- Institute of Nutritional Medicine, Department of Applied Nutritional Science/Dietetics, University of Hohenheim, Stuttgart, Germany
| | - Efstathios S Gonos
- Institute of Biological Research and Biotechnology, National Hellenic Research Foundation (NHRF, 48 Vas. Constantinou Ave, 11635, Athens, Greece
| | - Claudio Franceschi
- Institute of Information Technology, Mathematics and Mechanics, Department of Applied Mathematics, National Research Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
| | - Miriam Capri
- Department of Medical and Surgical Sciences, University of Bologna-Alma Mater Studiorum, Bologna, Italy
- Alma Mater Research Institute On Global Challenges and Climate Change (Alma Climate), University of Bologna, Bologna, Italy
| | - Ewa Sikora
- Laboratory of the Molecular Bases of Ageing, Polish Academy of Sciences, Nencki Institute of Experimental Biology, Warsaw, Poland
| | - Antti Hervonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mikko Hurme
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - P Eline Slagboom
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martijn E T Dollé
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Eugene Jansen
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Tilman Grune
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam , Potsdam, Germany
- Faculty of Chemistry, Department of Physiological Chemistry, University of Vienna, Vienna, Austria
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Alexander Bürkle
- Molecular Toxicology Group, Department of Biology, University of Konstanz, Constance, Germany
| | - Kristina Norman
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany.
- Institute of Nutritional Science, University of Potsdam , Potsdam, Germany.
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
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Müller-Werdan U. [Drug therapy for arterial hypertension and atrial fibrillation in frail patients : Are there any new insights and recommendations?]. Inn Med (Heidelb) 2024:10.1007/s00108-024-01681-8. [PMID: 38456903 DOI: 10.1007/s00108-024-01681-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/09/2024]
Abstract
The frail and elderly are considered to be at particular risk of suffering an adverse drug reaction. Empirical studies confirm the increased rate of adverse drug reactions. Whether frailty per se impairs drug metabolism or the underlying organ ageing processes and multimorbidity cannot be answered with certainty based on current data. Cardiovascular diseases exhibit a considerable interdependence with frailty. For example, there is a disproportionate syndromal interdependence between heart failure and frailty, and the typical ageing processes of the sinus node can be interpreted as heartbeat frailty. Multimorbidity in the elderly often includes a cluster of chronic cardiovascular diseases, often leading to the use of several cardiovascular medications as required. More recent definitions of polypharmacy assess the appropriateness of drugs rather than their number. The Fit-fOR-The-Aged (FORTA) list, the PRISCUS 2.0 list and the "Cochrane Library Special Collection on deprescribing", for example, offer a practice-oriented assessment aid. In the treatment of arterial hypertension, the target values for older people have also been set ever lower in recent years. In the case of frail elderly people, on the other hand, the guidelines do not specify a strict blood pressure target corridor; tolerability is the crucial factor here. When initiating antihypertensive therapy in frail individuals, one can consider monotherapy-in a departure from the standard case of dual combination therapy. The OPTIMISE study showed that discontinuation of one blood pressure medication did not lead to better tolerability of the drug therapy. Current studies come to differing conclusions regarding the risk-benefit assessment of new oral anticoagulants compared to vitamin K antagonists in the anticoagulation of frail elderly people with atrial fibrillation. Shared decision-making, which could improve adherence particularly in older people, is recommended.
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Affiliation(s)
- Ursula Müller-Werdan
- Medizinische Klinik für Geriatrie und Altersmedizin, Charité - Universitätsmedizin Berlin, Reinickendorfer Str. 61, 13347, Berlin, Deutschland.
- Evangelisches Geriatriezentrum Berlin, Reinickendorfer Str. 61, 13347, Berlin, Deutschland.
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Rosada A, Prpic M, Spieß E, Friedrich K, Neuwinger N, Müller-Werdan U, Kappert K. Underfilled blood collection tubes as pathologizing factor for measured laboratory parameters in older patients. J Am Geriatr Soc 2024. [PMID: 38314861 DOI: 10.1111/jgs.18790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Adrian Rosada
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Monika Prpic
- Institute of Diagnostic Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eileen Spieß
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Friedrich
- Institute of Diagnostic Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nick Neuwinger
- Institute of Diagnostic Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
| | - Ursula Müller-Werdan
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kai Kappert
- Institute of Diagnostic Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
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Döschner L, Schulze K, Göger L, Bosy-Westphal A, Krüger N, Franz K, Müller-Werdan U, Herpich C, Norman K. Effects of a Short-Term Vegan Challenge in Older Adults on Metabolic and Inflammatory Parameters-A Randomized Controlled Crossover Study. Mol Nutr Food Res 2024; 68:e2300623. [PMID: 38185769 DOI: 10.1002/mnfr.202300623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/20/2023] [Indexed: 01/09/2024]
Abstract
SCOPE A long-term vegan diet carries the risk of insufficient protein and micronutrient intake for older adults. However, even a short-term (48 h) vegan diet exerts positive metabolic effects in younger adults. In this study, we investigate the feasibility and effects of a short-term vegan challenge on metabolic and inflammatory markers in older adults. METHOD AND RESULTS In this randomized controlled crossover-study, 30 healthy older adults (≥65 years) are assigned to either a 48 h ad libitum vegan or omnivorous diet. During the vegan diet, participants exhibit lower protein (p = 0.001) and fat intake as well as higher carbohydrate and dietary fiber intake, resulting in a lower caloric intake (all p < 0.001). Insulin concentrations (p = 0.042) and insulin resistance (p = 0.036) decline only after the vegan diet. The study observes reductions in serum glucose (p < 0.001), triglyceride (p = 0.005), and hsCRP (p = 0.044) concentrations and weight (p < 0.001), independent of the diet. Participants with low-grade inflammation exhibit notable metabolic improvements after the vegan diet. CONCLUSION Improvements in insulin homeostasis are observed after the vegan diet, but meeting protein requirements are not feasible during the short-term vegan challenge despite dietary counseling, which warrants concern.
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Affiliation(s)
- Lary Döschner
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Kora Schulze
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Lea Göger
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbrücke, 14558, Nuthetal, Germany
| | - Anja Bosy-Westphal
- Institute for Human Nutrition and Food Science, Christian-Albrechts-University, 24098, Kiel, Germany
| | - Nele Krüger
- Institute of Nutritional Science, University of Potsdam, 14558, Nuthetal, Germany
| | - Kristina Franz
- Experimental and Clinical Research Center, a cooperation between Charité - Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine, 13125, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117, Berlin, Germany
- Max Delbrück Center, 13125, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785, Berlin, Germany
| | - Ursula Müller-Werdan
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany
- Evangelisches Geriatriezentrum Berlin gGmbH, 13347, Berlin, Germany
| | - Catrin Herpich
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbrücke, 14558, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, 14558, Nuthetal, Germany
| | - Kristina Norman
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbrücke, 14558, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, 14558, Nuthetal, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785, Berlin, Germany
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Ottens TH, Hermes C, Page V, Oldham M, Arora R, Bienvenu OJ, van den Boogaard M, Caplan G, Devlin JW, Friedrich ME, van Gool WA, Hanison J, Hansen HC, Inouye SK, Kamholz B, Kotfis K, Maas MB, MacLullich AMJ, Marcantonio ER, Morandi A, van Munster BC, Müller-Werdan U, Negro A, Neufeld KJ, Nydahl P, Oh ES, Pandharipande P, Radtke FM, Raedt SD, Rosenthal LJ, Sanders R, Spies CD, Vardy ERLC, Wijdicks EF, Slooter AJC. The Delphi Delirium Management Algorithms. A practical tool for clinicians, the result of a modified Delphi expert consensus approach. Delirium (Bielef) 2024; 2024:10.56392/001c.90652. [PMID: 38348284 PMCID: PMC10861222 DOI: 10.56392/001c.90652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Delirium is common in hospitalised patients, and there is currently no specific treatment. Identifying and treating underlying somatic causes of delirium is the first priority once delirium is diagnosed. Several international guidelines provide clinicians with an evidence-based approach to screening, diagnosis and symptomatic treatment. However, current guidelines do not offer a structured approach to identification of underlying causes. A panel of 37 internationally recognised delirium experts from diverse medical backgrounds worked together in a modified Delphi approach via an online platform. Consensus was reached after five voting rounds. The final product of this project is a set of three delirium management algorithms (the Delirium Delphi Algorithms), one for ward patients, one for patients after cardiac surgery and one for patients in the intensive care unit.
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Affiliation(s)
- Thomas H Ottens
- Intensive Care Unit, Haga Teaching Hospital
- Intensive Care Medicine, University Medical Center Utrecht
| | - Carsten Hermes
- Intensive Care Unit, Haga Teaching Hospital
- Intensive Care Medicine, University Medical Center Utrecht
- Critical Care, Watford General Hospital
- School of Medicine and Dentisty, University of Rochester
- Psychiatry, University of Rochester Medical Center
- Harrington Heart and Vascular Institute, University Hospitals of Cleveland
- Division of Cardiac Surgery, Case Western Reserve University
- School of Medicine, Johns Hopkins University
- Intensive Care Medicine, Radboud University Nijmegen Medical Centre
- School of Clinical Medicine, UNSW Sydney
- Geriatric Medicine, Prince of Wales Hospital
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital
- Bouve College of Health Sciences, Northeastern University
- Abteilung für Sozialpsychiatrie, Hollabrunn, Austria
- Neurology, Amsterdam University Medical Centers
- Anaesthesia, Manchester University NHS Foundation Trust
- Neurology, Friedrich-Ebert-Krankenhaus
- Beth Israel Deaconess Medical Center
- Harvard Medical School
- Anaesthesia, Intensive Care and Acute Poisoning, Pomeranian Medical University
- Neurology, Northwestern Medicine
- Feinberg School of Medicine, Northwestern University
- Usher Institute Ageing and Health, University of Edinburgh
- Geriatric Medicine, Beth Israel Deaconess Medical Center
- Rehabilitation, Fondazione Teresa Camplani
- Geriatric Medicine, University Medical Center Groningen
- Geriatrics, Charité - Universitätsmedizin Berlin
- Intensive Care Unit, IRCCS Ospedale San Raffaele
- Faculty of Health Sciences, McMaster University
- Intensive Care Unit, University Hospital Schleswig-Holstein
- Geriatric Medicine and Gerontology, Johns Hopkins Medicine
- Anesthesiology and Critical Care Medicine, Vanderbilt University Medical Center
- University of Southern Denmark
- Anaesthesia and Intensive Care, Nykøbing F. Hospital
- Vrije Universiteit Brussel
- Neurology, Universitair Ziekenhuis Brussel
- Psychiatry, Northwestern Memorial Hospital
- Faculty of Medicine and Health, University of Sydney
- Anaesthesiology and Intensive Care, Charité - Universitätsmedizin Berlin
- Northern Care Alliance NHS Foundation Trust, Oldham, United Kingdom
- University of Manchester, Manchester, United Kingdom
- Neurology, Mayo Clinic
- Psychiatry, University Medical Center Utrecht
- Brain Center, University Medical Center Utrecht
| | | | - Mark Oldham
- School of Medicine and Dentisty, University of Rochester
- Psychiatry, University of Rochester Medical Center
| | - Rakesh Arora
- Harrington Heart and Vascular Institute, University Hospitals of Cleveland
- Division of Cardiac Surgery, Case Western Reserve University
| | | | | | - Gideon Caplan
- School of Clinical Medicine, UNSW Sydney
- Geriatric Medicine, Prince of Wales Hospital
| | - John W Devlin
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital
- Bouve College of Health Sciences, Northeastern University
| | | | | | - James Hanison
- Anaesthesia, Manchester University NHS Foundation Trust
| | | | | | - Barbara Kamholz
- Intensive Care Unit, Haga Teaching Hospital
- Intensive Care Medicine, University Medical Center Utrecht
- Critical Care, Watford General Hospital
- School of Medicine and Dentisty, University of Rochester
- Psychiatry, University of Rochester Medical Center
- Harrington Heart and Vascular Institute, University Hospitals of Cleveland
- Division of Cardiac Surgery, Case Western Reserve University
- School of Medicine, Johns Hopkins University
- Intensive Care Medicine, Radboud University Nijmegen Medical Centre
- School of Clinical Medicine, UNSW Sydney
- Geriatric Medicine, Prince of Wales Hospital
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital
- Bouve College of Health Sciences, Northeastern University
- Abteilung für Sozialpsychiatrie, Hollabrunn, Austria
- Neurology, Amsterdam University Medical Centers
- Anaesthesia, Manchester University NHS Foundation Trust
- Neurology, Friedrich-Ebert-Krankenhaus
- Beth Israel Deaconess Medical Center
- Harvard Medical School
- Anaesthesia, Intensive Care and Acute Poisoning, Pomeranian Medical University
- Neurology, Northwestern Medicine
- Feinberg School of Medicine, Northwestern University
- Usher Institute Ageing and Health, University of Edinburgh
- Geriatric Medicine, Beth Israel Deaconess Medical Center
- Rehabilitation, Fondazione Teresa Camplani
- Geriatric Medicine, University Medical Center Groningen
- Geriatrics, Charité - Universitätsmedizin Berlin
- Intensive Care Unit, IRCCS Ospedale San Raffaele
- Faculty of Health Sciences, McMaster University
- Intensive Care Unit, University Hospital Schleswig-Holstein
- Geriatric Medicine and Gerontology, Johns Hopkins Medicine
- Anesthesiology and Critical Care Medicine, Vanderbilt University Medical Center
- University of Southern Denmark
- Anaesthesia and Intensive Care, Nykøbing F. Hospital
- Vrije Universiteit Brussel
- Neurology, Universitair Ziekenhuis Brussel
- Psychiatry, Northwestern Memorial Hospital
- Faculty of Medicine and Health, University of Sydney
- Anaesthesiology and Intensive Care, Charité - Universitätsmedizin Berlin
- Northern Care Alliance NHS Foundation Trust, Oldham, United Kingdom
- University of Manchester, Manchester, United Kingdom
- Neurology, Mayo Clinic
- Psychiatry, University Medical Center Utrecht
- Brain Center, University Medical Center Utrecht
| | - Katarzyna Kotfis
- Anaesthesia, Intensive Care and Acute Poisoning, Pomeranian Medical University
| | - Matthew B Maas
- Neurology, Northwestern Medicine
- Feinberg School of Medicine, Northwestern University
| | | | | | | | | | | | | | | | - Peter Nydahl
- Intensive Care Unit, University Hospital Schleswig-Holstein
| | - Esther S Oh
- Geriatric Medicine and Gerontology, Johns Hopkins Medicine
| | | | - Finn M Radtke
- University of Southern Denmark
- Anaesthesia and Intensive Care, Nykøbing F. Hospital
| | - Sylvie De Raedt
- Vrije Universiteit Brussel
- Neurology, Universitair Ziekenhuis Brussel
| | - Lisa J Rosenthal
- Feinberg School of Medicine, Northwestern University
- Psychiatry, Northwestern Memorial Hospital
| | | | - Claudia D Spies
- Anaesthesiology and Intensive Care, Charité - Universitätsmedizin Berlin
| | - Emma R L C Vardy
- Northern Care Alliance NHS Foundation Trust, Oldham, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | | | - Arjen J C Slooter
- Intensive Care Medicine, University Medical Center Utrecht
- Psychiatry, University Medical Center Utrecht
- Brain Center, University Medical Center Utrecht
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7
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Supthut W, Nuding S, Wienke A, Müller-Werdan U, Werdan K, Ebelt H. [Relationship between cardiac output, heart rate and microcirculation in patients with multiorgan dysfunction syndrome]. Med Klin Intensivmed Notfmed 2023:10.1007/s00063-023-01086-9. [PMID: 38038767 DOI: 10.1007/s00063-023-01086-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/15/2023] [Accepted: 10/29/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Multiple organ dysfunction syndrome (MODS) is one of the main causes of death in intensive care units. There is evidence that microcirculation in sepsis and coronary shock is regulated separately from hemodynamics. This study investigates the relationship between heart rate (HR), cardiac output (CO) and microcirculation in patients with MODS. METHODS This is a partial analysis of the "MODIFY study" (Reducing Elevated Heart Rate in Patients With Multiple Organ Dysfunction Syndrome [MODS] by Ivabradine). During the period 05/2010-09/2011, the microcirculation of 46 patients with septic and coronary MODS was measured using the sidestream dark field technique on the day of inclusion and 96 h later. Patients were randomized into a control and ivabradine treatment group. RESULTS Overall, there is a relevant improvement in microcirculation over time small perfused vessels, SPV [%] on day 0, d0:56.5 ± 34.2/d4:73.2 ± 22.1 (p = 0.03); perfused vessel density, PVDsmall [1/mm2] d0:7.5 ± 5.0/d4:9.8 ± 3.4 (p = 0.04); proportion of perfused vessels, PPVsmall [%] d0:51.6 ± 31.6/d4:66.7 ± 21.8 (p = 0.04); microcirculatory flow index, MFI d0:1.7 ± 1.0/d4:2.2 ± 0.7 (p = 0.05). Administration of ivabradine shows no effect. In patients with coronary MODS, there is a relevant correlation between microcirculatory parameters and cardiac output (SPV [%]: r = 0.98, p = 0.004). Patients with coronary MODS show better microcirculation values at high heart rates (> 100 bpm), while patients with septic MODS show an opposite relationship. CONCLUSION The results indicate that in critically ill patients, depending on the genesis of the MODS, there are different relationships between HF or CO values, on the one hand, and the parameters of the microcirculation, on the other.
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Affiliation(s)
- Wiebke Supthut
- Klinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland.
| | - Sebastian Nuding
- Medizinische Klinik II, Krankenhaus St. Elisabeth und St. Barbara, Halle (Saale), Deutschland
| | - Andreas Wienke
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Ursula Müller-Werdan
- Klinik für Geriatrie und Altersmedizin und EGZB, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Karl Werdan
- Klinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland
| | - Henning Ebelt
- Klinik für Innere Medizin II, Katholisches Krankenhaus St. Johann Nepomuk, Erfurt, Deutschland
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8
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Müller-Werdan U, Polidori MC, Simm A. On frailty and accelerated aging during SARS-Cov-2: senescence. Aging Clin Exp Res 2023; 35:907-912. [PMID: 36935472 PMCID: PMC10025062 DOI: 10.1007/s40520-023-02364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/04/2023] [Indexed: 03/21/2023]
Abstract
The COVID-19 pandemic is a burden for the worldwide healthcare systems. Whereas a clear age-dependent mortality can be observed, especially multimorbid and frail persons are at an increased risk. As bio-functional rather than calendrical age is in the meanwhile known to play a crucial role for COVID-19-related outcomes, aging-associated risk factors, overall prognosis and physiological age-related changes should be systematically considered for clinical decision-making. In this overview, we focus on cellular senescence as a major factor of biological aging, associated with organ dysfunction and increased inflammation (inflammaging).
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Affiliation(s)
- Ursula Müller-Werdan
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin and EGZB, Berlin, Germany
| | - M Cristina Polidori
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, Ageing Clinical Research, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Andreas Simm
- Clinic for Cardiac Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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9
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Perotti L, Stamm O, Mesletzky L, Vorwerg S, Fournelle M, Müller-Werdan U. Needs and Attitudes of Older Chronic Back Pain Patients towards a Wearable for Ultrasound Biofeedback during Stabilization Exercises: A Qualitative Analysis. Int J Environ Res Public Health 2023; 20:4927. [PMID: 36981835 PMCID: PMC10049307 DOI: 10.3390/ijerph20064927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 06/18/2023]
Abstract
Chronic back pain has a high prevalence, especially in older adults, and seriously affects sufferers' quality of life. Segmental stabilization exercise (SSE) is often used during physiotherapy to enhance core stability. The execution of SSE requires the selective contraction of deep abdominal and back muscles. Motor learning can be supported using ultrasound imaging as visual biofeedback. ULTRAWEAR is a mobile ultrasound system that provides deep learning-based biofeedback on SSE execution, which is currently under development. We interviewed 15 older chronic back pain patients (CBPPs) to investigate their pain management behavior, experience with SSE, as well as their needs and requirements for ULTRAWEAR. We also gathered information about future-usage scenarios. CBPPs reported a high willingness to use the system as a feedback tool both in physiotherapeutic practices and at home. The automated detection and evaluation of muscle contraction states was highlighted as a major benefit of the system compared to the more subjective feedback provided by traditional methods such as palpation. The system to be developed was perceived as a helpful solution to support learning about SSE.
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Affiliation(s)
- Luis Perotti
- Department of Geriatrics and Medical Gerontology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13347 Berlin, Germany
| | - Oskar Stamm
- Department of Geriatrics and Medical Gerontology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13347 Berlin, Germany
| | - Lisa Mesletzky
- Department of Geriatrics and Medical Gerontology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13347 Berlin, Germany
| | - Susan Vorwerg
- Department of Geriatrics and Medical Gerontology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13347 Berlin, Germany
| | - Marc Fournelle
- Department of Ultrasound, Fraunhofer Institute for Biomedical Engineering, 66280 Sulzbach, Germany
| | - Ursula Müller-Werdan
- Department of Geriatrics and Medical Gerontology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13347 Berlin, Germany
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10
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Strutz N, Brodowski H, Mümken SA, Müller-Werdan U, Kiselev J. Fall Risk and Coping of Older Adults After Hospitalization: A Mixed Methods Study. Gerontol Geriatr Med 2023; 9:23337214231152700. [PMID: 36755745 PMCID: PMC9900158 DOI: 10.1177/23337214231152700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/02/2023] [Accepted: 01/07/2023] [Indexed: 02/04/2023] Open
Abstract
Coping is defined as cognitive and behavioral effort to manage specific external and/or internal demands, such as managing one's own fall risk. Little is known about the relationship between the risk of falling in older adults and their coping strategies. The purpose of this study is to examine the fall risk after hospitalization, the adequacy of self-perceived fall risk and coping strategies of older adults. In this mixed-methods study, the adequacy of perceived fall risk was determined using the de Morton Mobility Index and the ABC Scale in 98 geriatric patients recruited in a geriatric hospital. Semi-structured interviews were conducted with a subsample of 16 participants 6 months after discharge to identify coping strategies. The six interviewees who adequately assessed their fall risk reported active/positive coping. In contrast, participants who assessed their fall risk inadequately (10 out of 16) reported passive/negative coping. Older adults who inadequately assessed their fall risk need special accompaniment in geriatric wards to develop active/positive coping strategies.
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Affiliation(s)
- Nicole Strutz
- Charité—Universitätsmedizin Berlin,
Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and
Berlin Institute of Health, Germany,Nicole Strutz, Geriatrics Research Group,
Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität
Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health,
Reinickendorfer Str. 61, Berlin 13347, Germany.
| | - Hanna Brodowski
- Institution of Health Sciences,
Department od Physiotherapy, Pain and Exercise Research Luebeck University of
Luebeck, Luebeck, Germany
| | - Sandra Angelika Mümken
- Charité—Universitätsmedizin Berlin,
Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and
Berlin Institute of Health, Germany
| | - Ursula Müller-Werdan
- Charité—Universitätsmedizin Berlin,
Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and
Berlin Institute of Health, Germany
| | - Joern Kiselev
- Charité—Universitätsmedizin Berlin,
Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and
Berlin Institute of Health, Germany
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11
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Kochlik B, Franz K, Henning T, Weber D, Wernitz A, Herpich C, Jannasch F, Aykaç V, Müller-Werdan U, Schulze MB, Grune T, Norman K. Frailty is characterized by biomarker patterns reflecting inflammation or muscle catabolism in multi-morbid patients. J Cachexia Sarcopenia Muscle 2023; 14:157-166. [PMID: 36377255 PMCID: PMC9891921 DOI: 10.1002/jcsm.13118] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 09/02/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Frailty development is partly dependent on multiple factors like low levels of nutrients and high levels of oxidative stress (OS) and inflammation potentially leading to a muscle-catabolic state. Measures of specific biomarker patterns including nutrients, OS and inflammatory biomarkers as well as muscle related biomarkers like 3-methylhistidine (3MH) may improve evaluation of mechanisms and the complex networks leading to frailty. METHODS In 220 multi-morbid patients (≥ 60 years), classified as non-frail (n = 104) and frail (n = 116) according to Fried's frailty criteria, we measured serum concentrations of fat-soluble micronutrients, amino acids (AA), OS, interleukins (IL) 6 and 10, 3MH (biomarker for muscle protein turnover) and serum spectra of fatty acids (FA). We evaluated biomarker patterns by principal component analysis (PCA) and their cross-sectional associations with frailty by multivariate logistic regression analysis. RESULTS Two biomarker patterns [principal components (PC)] were identified by PCA. PC1 was characterized by high positive factor loadings (FL) of carotenoids, anti-inflammatory FA and vitamin D3 together with high negative FL of pro-inflammatory FA, IL6 and IL6/IL10, reflecting an inflammation-related pattern. PC2 was characterized by high positive FL of AA together with high negative FL of 3MH-based biomarkers, reflecting a muscle-related pattern. Frail patients had significantly lower factor scores than non-frail patients for both PC1 [median: -0.27 (interquartile range: 1.15) vs. 0.27 (1.23); P = 0.001] and PC2 [median: -0.15 (interquartile range: 1.13) vs. 0.21 (1.38); P = 0.002]. Patients with higher PC1 or PC2 factor scores were less likely to be frail [odds ratio (OR): 0.62, 95% CI: 0.46-0.83, P = 0.001 for PC1; OR: 0.64, 95% CI: 0.48-0.86, P = 0.003 for PC2] compared with patients with lower PC1 or PC2 factor scores. This indicates that increasing levels of anti-inflammatory biomarkers and increasing levels of muscle-anabolic biomarkers are associated with a reduced likelihood (38% and 36%, respectively) for frailty. Significant associations remained after adjusting the regression models for potential confounders. CONCLUSIONS We conclude that two specific patterns reflecting either inflammation-related or muscle-related biomarkers are both significantly associated with frailty among multi-morbid patients and that these specific biomarker patterns are more informative than single biomarker analyses considering frailty identification.
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Affiliation(s)
- Bastian Kochlik
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam - Rehbruecke, Nuthetal, Germany.,NutriAct - Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany
| | - Kristina Franz
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thorsten Henning
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam - Rehbruecke, Nuthetal, Germany.,Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Daniela Weber
- NutriAct - Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany.,Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam - Rehbruecke, Nuthetal, Germany
| | - Andreas Wernitz
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Catrin Herpich
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam - Rehbruecke, Nuthetal, Germany.,Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Franziska Jannasch
- NutriAct - Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany.,Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Volkan Aykaç
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Protestant Geriatric Center Berlin (EGZB), Berlin, Germany
| | - Ursula Müller-Werdan
- Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Protestant Geriatric Center Berlin (EGZB), Berlin, Germany
| | - Matthias B Schulze
- NutriAct - Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany.,Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.,Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.,German Center for Diabetes Research (DZD), Muenchen, Neuherberg, Germany
| | - Tilman Grune
- NutriAct - Competence Cluster Nutrition Research Berlin-Potsdam, Nuthetal, Germany.,Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam - Rehbruecke, Nuthetal, Germany.,Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.,German Center for Diabetes Research (DZD), Muenchen, Neuherberg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Department of Physiological Chemistry, Faculty of Chemistry, University of Vienna, Vienna, Austria
| | - Kristina Norman
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam - Rehbruecke, Nuthetal, Germany.,Department of Geriatrics and Medical Gerontology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
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12
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Deutschbein J, Lindner T, Möckel M, Pigorsch M, Gilles G, Stöckle U, Müller-Werdan U, Schenk L. Health-related quality of life and associated factors after hip fracture. Results from a six-month prospective cohort study. PeerJ 2023; 11:e14671. [PMID: 36942001 PMCID: PMC10024485 DOI: 10.7717/peerj.14671] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/11/2022] [Indexed: 03/17/2023] Open
Abstract
Background Hip fractures are a major public health problem with increasing relevance in aging societies. They are associated with high mortality rates, morbidity, and loss of independence. The aim of the EMAAge study was to determine the impact of hip fractures on patient-reported health-related quality of life (HRQOL), and to identify potential risk factors for worse outcomes. Methods EMAAge is a multicenter, prospective cohort study of patients who suffered a hip fracture. Patients or, if necessary, proxies were interviewed after initial treatment and after six months using standardized questionnaires including the EQ-5D-5L instrument, the Oxford Hip Score, the PHQ-4, the Short Nutritional Assessment Questionnaire, and items on patients living situation. Medical data on diagnoses, comorbidities, medications, and hospital care were derived from hospital information systems. Results A total of 326 patients were included. EQ-5D index values decreased from a mean of 0.70 at baseline to 0.63 at six months. The mean self-rated health on the EQ-VAS decreased from 69.9 to 59.4. Multivariable linear regression models revealed three relevant associated factors with the six-months EQ-5D index: symptoms of depression and anxiety, pre-fracture limitations in activities of daily living, and no referral to a rehabilitation facility had a negative impact. In addition, the six-months EQ-VAS was negatively associated with polypharmacy, living in a facility, and migration background. Conclusions Hip fractures have a substantial negative impact on patients HRQOL. Our results suggest that there are modifying factors that need further investigation including polypharmacy and migration background. Structured and timely rehabilitation seems to be a protective factor.
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Affiliation(s)
- Johannes Deutschbein
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Germany
| | - Tobias Lindner
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Germany
| | - Martin Möckel
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Germany
| | - Mareen Pigorsch
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Germany
| | - Gabriela Gilles
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Germany
| | - Ulrich Stöckle
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculosceletal Surgery (CMSC), Germany
| | - Ursula Müller-Werdan
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Geriatrics and Medical Gerontology, Germany
| | - Liane Schenk
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Germany
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13
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Wilke S, Steiger E, Bärwolff TL, Kleine JF, Müller-Werdan U, Rosada A. Delirium in older hospitalized patients-A prospective analysis of the detailed course of delirium in geriatric inpatients. PLoS One 2023; 18:e0279763. [PMID: 36928887 PMCID: PMC10019648 DOI: 10.1371/journal.pone.0279763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/14/2022] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Delirium in older hospitalized patients (> 65) is a common clinical syndrome, which is frequently unrecognized. AIMS We aimed to describe the detailed clinical course of delirium and related cognitive functioning in geriatric patients in a mainly non-postoperative setting in association with demographic and clinical parameters and additionally to identify risk factors for delirium in this common setting. METHODS Inpatients of a geriatric ward were screened for delirium and in the case of presence of delirium included into the study. Patients received three assessments including Mini-Mental-Status-Examination (MMSE) and the Delirium Rating Scale Revised 98 (DRS-R-98). We conducted correlation and linear mixed-effects model analyses to detect associations. RESULTS Overall 31 patients (82 years (mean)) met the criteria for delirium and were included in the prospective observational study. Within one week of treatment, mean delirium symptom severity fell below the predefined cut-off. While overall cognitive functioning improved over time, short- and long-term memory deficits remained. Neuroradiological conspicuities were associated with cognitive deficits, but not with delirium severity. DISCUSSION The temporal stability of some delirium symptoms (short-/long-term memory, language) on the one hand and on the other hand decrease in others (hallucinations, orientation) shown in our study visualizes the heterogeneity of symptoms attributed to delirium and their different courses, which complicates the differentiation between delirium and a preexisting cognitive decline. The recovery from delirium seems to be independent of preclinical cognitive status. CONCLUSION Treatment of the acute medical condition is associated with a fast decrease in delirium severity. Given the high incidence and prevalence of delirium in hospitalized older patients and its detrimental impact on cognition, abilities and personal independence further research needs to be done.
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Affiliation(s)
- Skadi Wilke
- Department of Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Edgar Steiger
- Central Research Institute of Ambulatory Health Care in Germany (Zi), Berlin, Germany
| | - Tanja L. Bärwolff
- Department of Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Justus F. Kleine
- Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Adrian Rosada
- Department of Geriatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
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14
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Franz K, Deutschbein J, Riedlinger D, Pigorsch M, Schenk L, Lindner T, Möckel M, Norman K, Müller-Werdan U. Malnutrition is associated with six-month mortality in older patients admitted to the emergency department with hip fracture. Front Med (Lausanne) 2023; 10:1173528. [PMID: 37153099 PMCID: PMC10158933 DOI: 10.3389/fmed.2023.1173528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/30/2023] [Indexed: 05/09/2023] Open
Abstract
Background Hip fractures in older people are a common health problem often associated with malnutrition that might affect outcomes. Screening for malnutrition is not a routine examination in emergency departments (ED). This analysis of the EMAAge study, a prospective, multicenter cohort study, aimed to evaluate the nutritional status of older patients (≥ 50 years) with hip fracture, factors associated with malnutrition risk, and the association between malnutrition and the six-months mortality. Methods Risk of malnutrition was evaluated using the Short Nutritional Assessment Questionnaire. Clinical data as well as data on depression and physical activity were determined. Mortality was captured for the first six months after the event. To assess factors associated with malnutrition risk we used a binary logistic regression. A Cox proportional hazards model was used to assess the association of malnutrition risk with six-month survival adjusted for other relevant risk factors. Results The sample consisted of N = 318 hip fracture patients aged 50 to 98 (68% women). The prevalence of malnutrition risk was 25.3% (n = 76) at the time of injury. There were no differences in triage categories or routine parameters measured in the ED that could point to malnutrition. 89% of the patients (n = 267) survived for six months. The mean survival time was longer in those without malnutrition risk (171.9 (167.1-176.9) days vs. 153.1 (140.0-166.2) days). The Kaplan Meier curves and the unadjusted Cox regression (Hazard Ratio (HR) 3.08 (1.61-5.91)) showed differences between patients with and patients without malnutrition risk. In the adjusted Cox regression model, risk of death was associated with malnutrition risk (HR 2.61, 1.34-5.06), older age (70-76 years: HR 2.5 (0.52-11.99); 77-82 years: HR 4.25 (1.15-15.62); 83-99 years: HR 3.82 (1.05-13.88)) and a high burden of comorbidities (Charlson Comorbidity Index ≥3: HR 5.4 (1.53-19.12)). Conclusion Risk of malnutrition was associated with higher mortality after hip fracture. ED parameters did not differentiate between patients with nutritional deficiencies and those without. Therefore, it is particularly important to pay attention to malnutrition in EDs to detect patients at risk of adverse outcomes and to initiate early interventions.
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Affiliation(s)
- Kristina Franz
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Geriatrics and Medical Gerontology, Geriatrics Research Group, Berlin, Germany
- *Correspondence: Kristina Franz,
| | - Johannes Deutschbein
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Dorothee Riedlinger
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Berlin, Germany
| | - Mareen Pigorsch
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Liane Schenk
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Tobias Lindner
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Berlin, Germany
| | - Martin Möckel
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Berlin, Germany
| | - Kristina Norman
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Geriatrics and Medical Gerontology, Geriatrics Research Group, Berlin, Germany
| | - Ursula Müller-Werdan
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Geriatrics and Medical Gerontology, Geriatrics Research Group, Berlin, Germany
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Norman K, Herpich C, Müller-Werdan U. Role of phase angle in older adults with focus on the geriatric syndromes sarcopenia and frailty. Rev Endocr Metab Disord 2022; 24:429-437. [PMID: 36456777 PMCID: PMC9715408 DOI: 10.1007/s11154-022-09772-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
Age-related changes in body composition reflect an increased risk for disease as well as disability. Bioimpedance analysis is a safe and inexpensive bed side method to measure body composition, but the calculation of body compartments with BIA is hampered in older adults. Phase angle, a raw parameter derived from bioimpedance analysis, is free from calculation-inherent errors. It declines with age and disease and is highly predictive of a variety of clinical outcomes as well as mortality. This review summarizes the current evidence linking the phase angle to geriatric syndromes such as malnutrition, sarcopenia and frailty and also investigates whether the phase angle reacts to interventions. Since the majority of studies show an association between the phase angle and these geriatric syndromes, a low phase angle is not suitable to exclusively indicate a specific condition. It does not inform on the underlying cause and as such, a low phase angle mainly indicates increased risk. Phase angle decline over time is reflected by deterioration of e.g. frailty status. It reacts to physical training and detraining, but studies investigating whether these induced changes are also associated with improved outcome are missing.
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Affiliation(s)
- Kristina Norman
- Institute of Nutritional Science, University of Potsdam, 14558, Nuthetal, Germany.
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany.
- Department of Nutrition and Gerontology, German Institute for Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
| | - Catrin Herpich
- Institute of Nutritional Science, University of Potsdam, 14558, Nuthetal, Germany
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Ursula Müller-Werdan
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
- Evangelisches Geriatriezentrum Berlin gGmbH, Berlin, Germany
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Strutz N, Brodowski H, Kiselev J, Heimann-Steinert A, Müller-Werdan U. App-Based Evaluation of Older People's Fall Risk Using the mHealth App Lindera Mobility Analysis: Exploratory Study. JMIR Aging 2022; 5:e36872. [PMID: 35972785 PMCID: PMC9428783 DOI: 10.2196/36872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/07/2022] [Accepted: 06/27/2022] [Indexed: 12/04/2022] Open
Abstract
Background Falls and the risk of falling in older people pose a high risk for losing independence. As the risk of falling progresses over time, it is often not adequately diagnosed due to the long intervals between contacts with health care professionals. This leads to the risk of falling being not properly detected until the first fall. App-based software able to screen fall risks of older adults and to monitor the progress and presence of fall risk factors could detect a developing fall risk at an early stage prior to the first fall. As smartphones become more common in the elderly population, this approach is easily available and feasible. Objective The aim of the study is to evaluate the app Lindera Mobility Analysis (LIN). The reference standards determined the risk of falling and validated functional assessments of mobility. Methods The LIN app was utilized in home- and community-dwelling older adults aged 65 years or more. The Berg Balance Scale (BBS), the Tinetti Test (TIN), and the Timed Up & Go Test (TUG) were used as reference standards. In addition to descriptive statistics, data correlation and the comparison of the mean difference of analog measures (reference standards) and digital measures were tested. Spearman rank correlation analysis was performed and Bland-Altman (B-A) plots drawn. Results Data of 42 participants could be obtained (n=25, 59.5%, women). There was a significant correlation between the LIN app and the BBS (r=–0.587, P<.001), TUG (r=0.474, P=.002), and TIN (r=–0.464, P=.002). B-A plots showed only few data points outside the predefined limits of agreement (LOA) when combining functional tests and results of LIN. Conclusions The digital app LIN has the potential to detect the risk of falling in older people. Further steps in establishing the validity of the LIN app should include its clinical applicability. Trial Registration German Clinical Trials Register DRKS00025352; https://tinyurl.com/65awrd6a
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Affiliation(s)
- Nicole Strutz
- Geriatrics Research Group, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin), Berlin, Germany
| | - Hanna Brodowski
- Department of Physiotherapy, Pain and Exercise Research Lübeck, Institute of Health Sciences, University of Lübeck, Lübeck, Germany
| | - Joern Kiselev
- Department of Anesthesiology and Operative Intensive Care Medicine (Charité Campus Virchow Clinic/Campus Charité Mitte), Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin), Berlin, Germany
| | - Anika Heimann-Steinert
- Geriatrics Research Group, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin), Berlin, Germany
| | - Ursula Müller-Werdan
- Geriatrics Research Group, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin), Berlin, Germany
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Herpich C, Müller-Werdan U, Norman K. Role of plant-based diets in promoting health and longevity. Maturitas 2022; 165:47-51. [PMID: 35914402 DOI: 10.1016/j.maturitas.2022.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022]
Abstract
Western-style obesity-promoting diets are associated with increased inflammation, higher disease incidence and mortality. In contrast, plant-based diets (PBDs), which incorporate large amounts of vegetables and fruit, legumes, whole grains and only a small amount of meat, are generally associated with better health and lower mortality. This narrative review summarizes the evidence on health and life span in adults adhering to PBDs and discusses the potentially longevity-promoting mechanism of PBDs as well as limitations due to nutrient deficiencies. Epidemiologic studies consistently report lower mortality rates in adults who adhering to PBDs when compared with people whose diet regularly includes meat. PBDs are associated with many health benefits, such as improved metabolic and inflammatory profile. In turn, the incidence of cardiovascular disease is lower in adults consuming PBDs, which contributes to their better health. The health-promoting effects of PBDs are still not entirely clear but most likely multifactorial and include modulation of the gut microbiome. The interest in possible longevity-promoting mechanisms of PBDs has increased in recent years, as many characteristics of PBDs such as protein restriction and restriction of certain amino acids are known to extend the life span. While there is ample evidence from animal studies, large-scale human studies, which also provide insight into the specific mechanisms of the effect of PBDs on longevity, are missing. However, due to the lower protein content of PBDs, there appears to be an age limit for the anticipated health effects, as adults over 65 require larger amounts of protein.
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Affiliation(s)
- Catrin Herpich
- University of Potsdam, Institute of Nutritional Science, 14558 Nuthetal, Germany; Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Geriatrics and Medical Gerontology, Berlin, Germany
| | - Ursula Müller-Werdan
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Geriatrics and Medical Gerontology, Berlin, Germany; Evangelisches Geriatriezentrum Berlin gGmbH, Berlin, Germany
| | - Kristina Norman
- University of Potsdam, Institute of Nutritional Science, 14558 Nuthetal, Germany; Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Geriatrics and Medical Gerontology, Berlin, Germany; German Institute for Human Nutrition Potsdam-Rehbrücke, Department of Nutrition and Gerontology, 14558 Nuthetal, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
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18
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Strube-Lahmann S, Müller F, Liersch-Mazan D, Haink M, Müller-Werdan U, Lahmann NA. [Support needs of care dependent individuals : Survey of general and specific needs for information, assistance and support of care dependent individuals and their relatives]. Z Gerontol Geriatr 2022:10.1007/s00391-022-02068-w. [PMID: 35507083 PMCID: PMC9066130 DOI: 10.1007/s00391-022-02068-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2009, statutory regulations on information and counselling regarding nursing care needs, performed by so-called care advisors have been implemented for persons in need of long-term care and their relatives. In order to adequately prepare these care advisors, contemporary needs and requirements must be determined. The aim of the study was to determine the different needs of persons in need of long-term care and their relatives. METHOD Care advisors were interviewed via an online survey tool using a standardized questionnaire. A 5-point Likert scale was used to determine the needs regarding information and advice on 16 specific topics. In general, overall needs regarding information and advice of care recipients and relatives were recorded using a 10-point scale (1 low and 10 high). Using classification and regression trees (CRT) and random forest, the correlation between the individual main topics and the general need for advice was analyzed. RESULTS The participating care advisors (n = 276) rated the general demand for information of people in need of care and their relatives with a mean of 7.8 and 9.2, respectively. For those in need of care, the strongest association of general information needs was the topic of housing advice For the relatives, the topic social law aspects and benefits was the most relevant association. CONCLUSION The general demand for information was rated very high. Since differences became obvious between those in need of care and their relatives, it is necessary to adjust care advice for these two groups.
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Affiliation(s)
- Sandra Strube-Lahmann
- Forschungsgruppe Geriatrie, AG-Pflegeforschung, Medizinische Klinik für Geriatrie und Altersmedizin der Charité - Universitätsmedizin Berlin, Reinickendorfer Straße 61, 13347, Berlin, Deutschland.
- Geschäftsbereich hochschulische Aus- und Weiterbildung, Akademie der Gesundheit Berlin/Brandenburg e. V., Schwanebecker Chaussee 4 E-H, 13125, Berlin, Deutschland.
| | - Franziska Müller
- Forschungsgruppe Geriatrie, AG-Pflegeforschung, Medizinische Klinik für Geriatrie und Altersmedizin der Charité - Universitätsmedizin Berlin, Reinickendorfer Straße 61, 13347, Berlin, Deutschland
| | - Daniela Liersch-Mazan
- Forschungsgruppe Geriatrie, AG-Pflegeforschung, Medizinische Klinik für Geriatrie und Altersmedizin der Charité - Universitätsmedizin Berlin, Reinickendorfer Straße 61, 13347, Berlin, Deutschland
| | - Michele Haink
- Forschungsgruppe Geriatrie, AG-Pflegeforschung, Medizinische Klinik für Geriatrie und Altersmedizin der Charité - Universitätsmedizin Berlin, Reinickendorfer Straße 61, 13347, Berlin, Deutschland
| | - Ursula Müller-Werdan
- Forschungsgruppe Geriatrie, AG-Pflegeforschung, Medizinische Klinik für Geriatrie und Altersmedizin der Charité - Universitätsmedizin Berlin, Reinickendorfer Straße 61, 13347, Berlin, Deutschland
| | - Nils A Lahmann
- Fakultät Gesundheitswissenschaften, Medical School Berlin , Berlin, Deutschland
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Feist B, Feindt B, Kasprick L, Baerwald C, Simm A, Müller-Werdan U, Sultzer R, Behrens J. Prüfung des Screening-Tools GeriNOT. Z Gerontol Geriatr 2022; 56:201-208. [PMID: 35399117 DOI: 10.1007/s00391-022-02054-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Geriatric-specific characteristics influence patient-relevant outcomes of inpatient hospital care in patients aged 70 years and older: prolonged length of stay, complications, increase in utilization of required services as well as mortality rates. OBJECTIVE The screening tool GeriNOT, identification of geriatric risk potential with 7 items, of which mobility and cognition are double-weighted, score 9 points, was tested for its predictive content and diagnostic quality. MATERIAL AND METHODS Diagnostic study from a retrospective, bicentric complete survey in all types of admission from 70 years with 2541 patient cases. Regression analyses in linked samples of the 7 items in GeriNOT and as noncombined end points: prolonged length of stay, complications, increase in need-based service at discharge and death. RESULTS Mean age ± SD: 77.0 ± 6.4 years. ROC analyses report at a cut-off value calculated using the Youden index of ≥ 4 points in 2541 cases: increase in need-based service at discharge (AUC = 0.693, 95% CI = 0.663-0.723, sensitivity 75.2%, specificity 59.7%), complications (AUC = 0.662, 95% CI = 0.636-0.688, sensitivity 64.2%, specificity 61.6%) and death (AUC = 0.734, 95% CI = 0.682-0.786, sensitivity 76.4%, specificity 57.5%). Possibly suitable for use as screening to identify geriatric risk potentials at a cut-off of ≥ 4 points. DISCUSSION Provide an initial filter screening with regard to mobility. Such identification could provide the involved persons with the opportunity for an improved treatment outcome by adapting the inpatient process. Prospective validation of GeriNOT needed.
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Stamm O, Dahms R, Reithinger N, Ruß A, Müller-Werdan U. Virtual reality exergame for supplementing multimodal pain therapy in older adults with chronic back pain: a randomized controlled pilot study. Virtual Real 2022; 26:1291-1305. [PMID: 35194374 PMCID: PMC8831688 DOI: 10.1007/s10055-022-00629-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/10/2022] [Indexed: 05/07/2023]
Abstract
Immersive Virtual Reality (VR) with head-mounted displays (HMD) can be a promising tool for increasing adherence to exercise in older adults. However, there is little known about the effectiveness of an interactive multimodal therapy in VR for older chronic back pain (CBP) patients. The aim of the exploratory randomized controlled trial was to examine the preliminary effectiveness of a VR multimodal therapy for older adults with CBP in a laboratory setting over a period of four weeks. The intervention group (IG; n = 11) received a multimodal pain therapy in VR (movement therapy and psychoeducation) and the control group (CG; n = 11) received a conventional multimodal pain therapy (chair-based group exercises and psychoeducation in a group setting). Although the VR therapy (IG) did not reach the pain intensity reduction of the CG (IG: MD = 0.64, p = .535; CG: MD = 1.64, p = .07), both groups showed a reduction in pain intensity on the Numeric Rating Scale. The functional capacity in the IG improved from Visit 1, x ¯ = 73.11% to Visit 2, x ¯ = 81.82% (MD = 8.71%; p = .026). In the changes of fear avoidance beliefs and general physical and mental health, no significance was achieved in either group. Although the IG did not reach a significant pain intensity reduction compared to the CG, the results of the present study showed that a pain intensity reduction can be achieved with the current VR application.
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Affiliation(s)
- Oskar Stamm
- Department of Geriatrics and Medical Gerontology, Working Group Age and Technology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Reinickendorfer Straße 61, 13347 Berlin, Germany
| | - Rebecca Dahms
- Department of Geriatrics and Medical Gerontology, Working Group Age and Technology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Reinickendorfer Straße 61, 13347 Berlin, Germany
| | - Norbert Reithinger
- DFKI, Deutsches Forschungszentrum Für Künstliche Intelligenz GmbH (DFKI), Alt-Moabit 91c, 10559 Berlin, Germany
| | - Aaron Ruß
- DFKI, Deutsches Forschungszentrum Für Künstliche Intelligenz GmbH (DFKI), Alt-Moabit 91c, 10559 Berlin, Germany
| | - Ursula Müller-Werdan
- Department of Geriatrics and Medical Gerontology, Working Group Age and Technology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Reinickendorfer Straße 61, 13347 Berlin, Germany
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21
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Barcena ML, Niehues MH, Christiansen C, Estepa M, Haritonow N, Sadighi AH, Müller-Werdan U, Ladilov Y, Regitz-Zagrosek V. Male Macrophages and Fibroblasts from C57/BL6J Mice Are More Susceptible to Inflammatory Stimuli. Front Immunol 2021; 12:758767. [PMID: 34867999 PMCID: PMC8637417 DOI: 10.3389/fimmu.2021.758767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/22/2021] [Indexed: 12/12/2022] Open
Abstract
Mounting evidence argues for the significant impact of sex in numerous cardiac pathologies, including myocarditis. Macrophage polarization and activation of cardiac fibroblasts play a key role in myocardial inflammation and remodeling. However, the role of sex in these processes is still poorly understood. In this study, we investigated sex-specific alterations in the polarization of murine bone marrow-derived macrophages (BMMs) and the polarization-related changes in fibroblast activation. Cultured male and female murine BMMs from C57/BL6J mice were polarized into M1 (LPS) and M2 (IL-4/IL-13) macrophages. Furthermore, male and female cardiac fibroblasts from C57/BL6J mice were activated with TNF-α, TGF-β, or conditioned medium from M1 BMMs. We found a significant overexpression of M1 markers (c-fos, NFκB, TNF-α, and IL-1β) and M2 markers (MCP-1 and YM1) in male but not female activated macrophages. In addition, the ROS levels were higher in M1 male BMMs, indicating a stronger polarization. Similarly, the pro-fibrotic markers TGF-β and IL-1β were expressed in activated cardiac male fibroblasts at a significantly higher level than in female fibroblasts. In conclusion, the present study provides strong evidence for the male-specific polarization of BMMs and activation of cardiac fibroblasts in an inflammatory environment. The data show an increased inflammatory response and tissue remodeling in male mice.
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Affiliation(s)
- Maria Luisa Barcena
- Department of Geriatrics and Medical Gerontology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin Partner Site, Berlin, Germany
| | - Maximilian H Niehues
- Department of Geriatrics and Medical Gerontology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Céline Christiansen
- Department of Geriatrics and Medical Gerontology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Misael Estepa
- Department of Geriatrics and Medical Gerontology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Internal Medicine and Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Natalie Haritonow
- Department of Geriatrics and Medical Gerontology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Amir H Sadighi
- Department of Geriatrics and Medical Gerontology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ursula Müller-Werdan
- Department of Geriatrics and Medical Gerontology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Yury Ladilov
- Institute for Gender in Medicine, Center for Cardiovascular Research, Charité University Hospital, Berlin, Germany
| | - Vera Regitz-Zagrosek
- Institute for Gender in Medicine, Center for Cardiovascular Research, Charité University Hospital, Berlin, Germany.,Department of Cardiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
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Lahmann NA, Müller-Werdan U, Kuntz S, Klingehöfer-Noe J, Jaenicke F, Strube-Lahmann S. Conception and evaluation of a washable multimodal smart textile. Health Technol 2021. [DOI: 10.1007/s12553-021-00619-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractSmart textiles can support people with specific needs and diseases, such as diabetes or heart disease. Currently there are efforts to combine continuous mobile monitoring with other health-related conditions. On this basis, algorithms could be developed that can be used to detect unusual or critical conditions. A study was to investigate whether a previously developed washable Multi-Modal Smart Textile (MMST), based on inexpensive materials, would provide valid and reliable results with regard to the vital parameters of pulse, temperature and mobility. The measurement of the vital parameters was carried out with the developed prototype MMST as well as with validated devices. All electronics including the rechargeable NiMH has been washed more than 30 times with different methods and it remained fully functional. The intraclass correlation coefficients (ICC) for pulse (temperature) measurement ranged between 0.036 and 0.232 (0.077 and 0.817) depending on the activity of the tested individuals (standing, sitting, lying down, moving). Cohen’s Kappa for the detection of the body position was 0.765. For the parameter of pulse, the results indicated an insufficient derivation for both validity and reliability. Due to flaws in the methodology applied, the validly and reliably for the parameter of temperature could not be determined. Valid and reliable results were obtained for the parameter mobility/change of position. If the MMST (after modification of the prototype) achieves reliable results, there are many advantages for people giving and receiving care on a budget price, even in threatening emergency situations.
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23
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Nitschke I, Frank F, Müller-Werdan U, Eckardt-Felmberg R, Stillhart A. Denture-related problems of patients in acute geriatric care. Z Gerontol Geriatr 2021; 55:318-324. [PMID: 34170352 PMCID: PMC9213273 DOI: 10.1007/s00391-021-01928-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/19/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND With increasing frailty and complaint-oriented utilization of dental care, the prevalence of oral diseases also increases. AIM To clarify whether there is a need for dental prosthodontic treatment during residential acute geriatric rehabilitation. METHODS Within 3 weeks in a hospital for acute geriatric patients, 79 out of 157 newly admitted patients were interviewed as study participants (age: median 79.0 years, range 66-96 years, female 51.9%), dental findings were recorded, treatment needs were determined but X‑rays were not taken. RESULTS Of the participants 31.1% had not seen a dentist for more than 1 year and 18.2% were edentulous. The median number of teeth in dentate participants was 16 (range 1-28 teeth); based on all participants, there was a median of 12.0 teeth (range 0-28 teeth). Of the 52 denture wearers (45 upper jaw and 43 lower jaw), 5 each of the maxillary and mandibular dentures could not be assessed because they were not available at the hospital. Moderate denture deficiencies were present in 62.5% of participants wearing upper dentures (mandibular 55.3%). CONCLUSION Dental treatment is needed in this vulnerable patient group. Therefore, the oral cavity should be assessed as part of the geriatric assessment. The available data confirm that the use of validated assessment instruments, such as the mini dental assessment as part of the comprehensive geriatric assessment would be useful. In addition to an oral examination, simple dental treatment should be provided to reduce infections and improve chewing ability. The geriatrician should be informed of the urgency of treatment. The overall rehabilitative approach of acute geriatric treatment would be complete if oral health would not be excluded.
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Affiliation(s)
- Ina Nitschke
- Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland. .,Division of Gerodontology, Clinic of Prosthetic Dentistry and Dental Materials Science, Leipzig University Medical Center, Leipzig, Germany.
| | - Frederick Frank
- Division of Gerodontology, Clinic of Prosthetic Dentistry and Dental Materials Science, Leipzig University Medical Center, Leipzig, Germany
| | - Ursula Müller-Werdan
- Department of Geriatrics and Medical Gerontology, Charité-Universitätsmedizin Berlin, and Protestant Geriatric Center Berlin, Berlin, Germany
| | | | - Angela Stillhart
- Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Jachan DE, Müller-Werdan U, Lahmann NA, Strube-Lahmann S. Smart@home - supporting safety and mobility of elderly and care dependent people in their own homes through the use of technical assistance systems and conventional mobility supporting tools: a cross-sectional survey. BMC Geriatr 2021; 21:205. [PMID: 33761880 PMCID: PMC7992959 DOI: 10.1186/s12877-021-02118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 02/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background The use of technical solutions and conventional mobility supporting aids can support the independence of people into old age in their own homes. However, we found relatively few empirical investigations on the effects and costs of these systems. Methods The aim of the study was to investigate usability, user satisfaction and the correlation between costs and benefits of different built-in smart home solutions and conventional mobility supporting tools in the home of elderly, partially care-dependent tenants (> 65 years). A cross-sectional survey was conducted from February to March 2018 with tenants of a housing association in apartments equipped with smart home technology and conventional mobility supporting tools. The response rate in the intervention group was n = 37 persons (out of 46 tenants with installed smart home and conventional solutions) and in the control group n = 64 persons (out of 100 tenants without built-in smart home and conventional solutions). Data were collected by a written questionnaire regarding usability and satisfaction of the tenants with the built-in smart home solutions and conventional mobility supporting tools. In addition, both the intervention and the control group were asked general questions about communication, safety and how to deal with the need for long-term care in their own living environment. Results Results showed that with regard to usability, satisfaction and price performance ratio of the installed smart home solutions, the installation of the corresponding solutions with an overall score of 1.41 (on a scale of 1 (very good) to 6 (unsatisfactory)) was mostly positively evaluated by the tenants. Overall, users rated the installed smart home solutions better than the conventional mobility supporting tools (such as handholds and increased balcony floor level). Conclusions Analysis of the price performance ratio showed that smart home solutions are generally more expensive than conventional tools, but also contribute significantly to an increased security of the tenants, and thus may enable longer living in a familiar environment. We recommend modularized offers consisting of various components of smart home solutions, since this significantly reduces installation costs and allows for an individual composition according to requirements. Moreover, smart home solutions should be considered to be listed as medical aids. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02118-9.
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Affiliation(s)
- Deborah Elisabeth Jachan
- Department of Geriatrics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany. .,Department of Geriatrics, Geriatrics Research Group, Charité - Universitätsmedizin Berlin, Reinickendorfer Straße 61, 13347, Berlin, Germany.
| | - Ursula Müller-Werdan
- Department of Geriatrics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Nils Axel Lahmann
- Department of Geriatrics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sandra Strube-Lahmann
- Department of Geriatrics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
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John S, Riessen R, Karagiannidis C, Janssens U, Busch HJ, Kochanek M, Michels G, Hermes C, Buerke M, Kluge S, Baumgärtel M, Braune S, Erbguth F, Fuhrmann V, Lebiedz P, Mayer K, Müller-Werdan U, Oppert M, Sayk F, Sedding D, Willam C, Werdan K. [Core curriculum Medical intensive care medicine of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN)]. Med Klin Intensivmed Notfmed 2021; 116:1-45. [PMID: 33427907 PMCID: PMC7799161 DOI: 10.1007/s00063-020-00765-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/25/2022]
Abstract
Medical intensive care medicine treats patients with severe, potentially life-threatening diseases covering the complete spectrum of internal medicine. The qualification in medical intensive care medicine requires a broad spectrum of knowledge and skills in medical intensive care medicine, but also in the general field of internal medicine. Both sides of the coin must be taken into account, the treatment with life-sustaining strategies of the acute illness of the patient and also the treatment of patient's underlying chronic diseases. The indispensable foundation of medical intensive care medicine as described in this curriculum includes basic knowledge and skills (level of competence I-III) as well as of behavior and attitudes. This curriculum is primarily dedicated to the internist in advanced training in medical intensive care medicine. However, this curriculum also intends to reach trainers in intensive care medicine and also the German physician chambers with their examiners, showing them which knowledge, skills as well as behavior and attitudes should be taught to trainees according to the education criteria of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN).
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Affiliation(s)
- S John
- Klinikum Nürnberg-Süd, Medizinische Klinik 8, Abteilung für Internistische Intensivmedizin, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - R Riessen
- Dept. für Innere Medizin, Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - C Karagiannidis
- ARDS und ECMO Zentrum Köln-Merheim, Professur für extrakorporale Lungenersatzverfahren der Universität Witten-Herdecke, Abteilung Pneumologie, Intensiv- und Beatmungsmedizin, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - U Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - M Kochanek
- Klinik I für Innere Medizin (Hämatologie und Onkologie), Schwerpunkt Internistische Intensivmedizin, Universitätsklinikum Köln, Köln, Deutschland
| | - G Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Akademisches Lehrkrankenhaus der RWTH Aachen, Eschweiler, Deutschland
| | | | - M Buerke
- Medizinische Klinik II, St. Marien-Krankenhaus Siegen, Siegen, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Baumgärtel
- Klinikum Nürnberg-Nord, Intensivstation 10/II, Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - S Braune
- IV. Med. Klinik - Internistische Intensivmedizin und Notaufnahme, Franziskus-Hospital Münster, Münster, Deutschland
| | - F Erbguth
- Klinikum Nürnberg, Universitätsklinik für Neurologie, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | - V Fuhrmann
- Klinik für Innere Medizin I, Evangelisches Klinikum Niederrhein, Duisburg, Deutschland
| | - P Lebiedz
- Klinik für Innere Medizin und Internistische Intensivmedizin, Ev. Krankenhaus Oldenburg, Steinweg 13-17, Oldenburg, Deutschland
| | - K Mayer
- Medizinische Klinik 4, Pneumologie und Schlafmedizin, ViDia Kliniken, Karlsruhe, Deutschland
| | - U Müller-Werdan
- Klinik für Geriatrie und Altersmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Evangelisches Geriatriezentrum Berlin (EGZB), Berlin, Deutschland
| | - M Oppert
- Klinik für Notfall- und Intensivmedizin, Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - F Sayk
- Campus Lübeck, Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - D Sedding
- Universitätsklinikum Halle (Saale), Klinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland
| | - C Willam
- Universitätsklinikum Erlangen, Medizinische Klinik 4, Nephrologie und Hypertensiologie, Friedrich-Alexander-Universität Erlangen, Erlangen, Deutschland
| | - K Werdan
- Universitätsklinikum Halle (Saale), Klinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland.
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Strube-Lahmann S, Müller-Werdan U, Norman K, Skarabis H, Lahmann NA. Underweight in Nursing Homes: Differences between Men and Women. Gerontology 2021; 67:211-219. [PMID: 33472200 DOI: 10.1159/000512459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In Germany, there is an ongoing concern about the high prevalence of underweight on admission to health-care institutions. In order to assess possible sex-specific differences, the aim of this study is to provide valid figures about the prevalence and risk factors of underweight of men and women in German nursing homes. MATERIAL AND METHODS A secondary data analysis of 8 annual consecutive cross-sectional studies of 19,686 residents from 280 nursing homes was conducted from 2009 to 2016. Underweight was defined as BMI < 18.5 (<20) for individuals <65 years (≥65 years). For statistical modeling, we used classification and regression trees (CRTs) and random forest in "R." RESULTS Average prevalence of underweight in nursing home residents was 13.7% (13.2-14.2). Initial descriptive results showed that the prevalence of underweight among women was 15.6% (15.0-16.2) and the prevalence of underweight among men was 7.5% (6.7-8.2). The CRT-based modeling indicated that "loss of appetite" as the most important indicator for low BMI. If "loss of appetite" was present, prevalence of underweight increased from 13.5 to 39.1%. Other important indicators were "very large institutions" and the "resident/nurse ratio." The random forest analysis confirmed the importance of the CRT approach. DISCUSSION/CONCLUSION The multivariate approach revealed that the role of sex for being underweight in nursing homes is marginal. To avoid higher morbidity and mortality in this group, nutritional intervention by clinical practitioners to increase appetite should be given high priority, especially in large long-term care institutions.
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Affiliation(s)
- Sandra Strube-Lahmann
- Geriatrics Research Group Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ursula Müller-Werdan
- Geriatrics Research Group Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kristina Norman
- Geriatrics Research Group Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,German Institute of Human Nutrition Potsdam Rehbrücke, Nuthetal, Potsdam, Germany
| | - Horst Skarabis
- Emeritus Professor for Statistics at the Freie Universität Berlin, Berlin, Germany
| | - Nils Axel Lahmann
- Geriatrics Research Group Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,
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Heimann-Steinert A, Latendorf A, Prange A, Sonntag D, Müller-Werdan U. Digital pen technology for conducting cognitive assessments: a cross-over study with older adults. Psychol Res 2020; 85:3075-3083. [PMID: 33331957 PMCID: PMC8476387 DOI: 10.1007/s00426-020-01452-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
Many digitalized cognitive assessments exist to increase reliability, standardization, and objectivity. Particularly in older adults, the performance of digitized cognitive assessments can lead to poorer test results if they are unfamiliar with the computer, mouse, keyboard, or touch screen. In a cross-over design study, 40 older adults (age M = 74.4 ± 4.1 years) conducted the Trail Making Test A and B with a digital pen (digital pen tests, DPT) and a regular pencil (pencil tests, PT) to identify differences in performance. Furthermore, the tests conducted with a digital pen were analyzed manually (manual results, MR) and electronically (electronic results, ER) by an automized system algorithm to determine the possibilities of digital pen evaluation. ICC(2,k) showed a good level of agreement for TMT A (ICC(2,k) = 0.668) and TMT B (ICC(2,k) = 0.734) between PT and DPT. When comparing MR and ER, ICC(2,k) showed an excellent level of agreement in TMT A (ICC(2,k) = 0.999) and TMT B (ICC(2,k) = 0.994). The frequency of pen lifting correlates significantly with the execution time in TMT A (r = 0.372, p = 0.030) and TMT B (r = 0.567, p < 0.001). A digital pen can be used to perform the Trail Making Test, as it has been shown that there is no difference in the results due to the type of pen used. With a digital pen, the advantages of digitized testing can be used without having to accept the disadvantages.
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Affiliation(s)
- A Heimann-Steinert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Geriatrics Research Group, Reinickendorfer Str. 61, 13347, Berlin, Germany.
| | - A Latendorf
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Geriatrics Research Group, Reinickendorfer Str. 61, 13347, Berlin, Germany
| | - A Prange
- German Research Center for Artificial Intelligence (DFKI GmbH), Stuhlsatzenhausweg 3, 66123, Saarbruecken, Germany
| | - D Sonntag
- German Research Center for Artificial Intelligence (DFKI GmbH), Stuhlsatzenhausweg 3, 66123, Saarbruecken, Germany
| | - U Müller-Werdan
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Geriatrics Research Group, Reinickendorfer Str. 61, 13347, Berlin, Germany
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Herpich C, Franz K, Klaus S, Müller-Werdan U, Ost M, Norman K. Age-related fatigue is associated with reduced mitochondrial function in peripheral blood mononuclear cells. Exp Gerontol 2020; 144:111177. [PMID: 33279665 DOI: 10.1016/j.exger.2020.111177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Fatigue is a complex syndrome associated with exhaustion not relieved by sleep. It occurs frequently in older adults in the context of chronic disease and is associated with decreased physical capacity. Whether a mitochondrial dysfunction and therefore an impaired energy production might contribute to the development of fatigue during aging is yet unknown. The aim of this study was to evaluate mitochondrial respiration of peripheral blood mononuclear cells (PBMCs) in older patients with and without fatigue. METHOD Fatigue was determined according to the Brief Fatigue Inventory. Mitochondrial respiration of freshly isolated PBMCs was investigated by high-resolution respirometry using the Oroboros Oxygraph-O2k. Functional impairment and depressive symptoms were assessed using questionnaires. RESULTS 23 geriatric patients (77.8 ± 4.9 years; 43.5% female) with fatigue and 22 without fatigue (75.4 ± 5.4 years; 45.5% female) were analyzed. Patients with fatigue exhibited more functional limitations and more depressive symptoms. High-resolution respirometry of intact PBMCs revealed a lower routine (4.82 ± 1.14 pmol/s versus 5.89 ± 1.90 pmol/s, p = 0.041) and maximum (6.55 ± 1.51 pmol/s versus 8.43 ± 3.67 pmol/s, p = 0.013) oxygen consumption rate, resulting in a reduced ATP-linked respiration (4.26 ± 1.00 pmol/s versus 5.09 ± 1.53 pmol/s, p = 0.035) of PBMCs from geriatric patients with fatigue compared to controls without. CONCLUSIONS This short report shows that in this group of older patients, fatigue is associated with lower PBMC mitochondrial respiration. Whether the impaired mitochondrial respiration is accompanied by a reduced mitochondrial activity in other organs (e.g. muscle) remains to be elucidated.
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Affiliation(s)
- Catrin Herpich
- German Institute of Human Nutrition, Potsdam - Rehbrücke, Department of Nutrition and Gerontology, Nuthetal, Germany
| | - Kristina Franz
- German Institute of Human Nutrition, Potsdam - Rehbrücke, Department of Nutrition and Gerontology, Nuthetal, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Susanne Klaus
- German Institute of Human Nutrition, Potsdam - Rehbrücke, Department of Physiology of Energy Metabolism, Nuthetal, Germany; University of Potsdam, Institute of Nutritional Science, Potsdam, Germany
| | - Ursula Müller-Werdan
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Germany; Protestant Geriatric Center Berlin, Berlin, Germany
| | - Mario Ost
- German Institute of Human Nutrition, Potsdam - Rehbrücke, Department of Physiology of Energy Metabolism, Nuthetal, Germany; University Hospital Leipzig, Department of Neuropathology, Leipzig, Germany
| | - Kristina Norman
- German Institute of Human Nutrition, Potsdam - Rehbrücke, Department of Nutrition and Gerontology, Nuthetal, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Germany; University of Potsdam, Institute of Nutritional Science, Potsdam, Germany.
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Franz K, Unterleider N, Rödel A, Rochau J, Rothfelder T, Aykac V, Müller-Werdan U, Norman K. Frailty syndrome in old patients with chronic wounds: data from a prospective, longitudinal observational study (WONDER). Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Vorwerg S, Stamm O, Menant A, Alex S, Müller-Werdan U. Observational study in cardiac rehabilitation groups phase III: a comparison of perceived and measured training intensity during a moderate-intensity workout. Eur J Phys Rehabil Med 2020; 57:414-423. [PMID: 33215904 DOI: 10.23736/s1973-9087.20.06379-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND During the last 25 years, the absolute number of cases of cardiovascular disease has increased in Europe. The goal in cardiac rehabilitation (CR) groups phase III is to motivate participants to demonstrate exercises independently of the group and self-reliant in long-term. In this context, it is of great importance to teach participants the appropriate training intensity. Adjusting the intensity of the training in CR groups is essential in order to avoid the dangers of overexertion and undertraining. AIM This study aimed to examine whether participants in CR groups could correctly assess their exertion and thus achieve their predefined training intensity. DESIGN Observational study. SETTING The setting of the study was an outpatient rehabilitation center. POPULATION Forty-one people from CR groups phase III, with cardiovascular diseases, were included in the study. METHODS The training focused on moderate-intensity activity. The Borg Scale was used to evaluate how participants rated their exertion. The heart rate was recorded with the Polar M600 during the entire training period to compare it with the estimated exertion. RESULTS Sixty-five percent (65%) of the participants was trained within their prescribed training intensity. However, they rated the perceived exertion significantly higher than the measured HR (P<0.001). The difference between target training HR and measured HR was also significant (P=0.008). There were significant differences between the groups of moderate-intensity endurance training and moderate-intensity strength endurance training (P=0.002). CONCLUSIONS The participants in the CR groups could assess their own exertion moderately well. On the one hand, there were difficulties in accurately estimating the perceived exertion compared to the actual exertion. On the other hand, overloading and underloading were hardly detected. CLINICAL REHABILITATION IMPACT The perception of exertion must be improved by knowing one's own training heart rate and intensity. Therefore, wearables such as smartwatches could be useful monitoring aids for CR groups to check if the predefined training intensity will be reached.
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Affiliation(s)
- Susan Vorwerg
- Working Group Aging and Technology, Geriatrics Research Group, Charité - Universitätsmedizin Berlin, Berlin, Germany -
| | - Oskar Stamm
- Working Group Aging and Technology, Geriatrics Research Group, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Audrey Menant
- Department of Biology of Aging and Longevity, Faculty of Sciences, Sorbonne University, Paris, France
| | - Sven Alex
- Sport-Gesundheitspark Berlin e.V. - Zentrum für Sportmedizin, Berlin, Germany
| | - Ursula Müller-Werdan
- Working Group Aging and Technology, Geriatrics Research Group, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Affiliation(s)
- Thea Koch
- Department of Anesthesiology and Intensive Care Medicine, Dresden University Hospital
| | - Ursula Müller-Werdan
- Department of Geriatric Medicine, Charité—University Medical Center Berlin, and Protestant Geriatric Center Berlin
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Stamm O, Dahms R, Müller-Werdan U. Virtual reality in pain therapy: a requirements analysis for older adults with chronic back pain. J Neuroeng Rehabil 2020; 17:129. [PMID: 32993678 PMCID: PMC7523056 DOI: 10.1186/s12984-020-00753-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Today immersive environments such as Virtual Reality (VR) offer new opportunities for serious gaming in exercise therapy and psychoeducation. Chronic back pain (CBP) patients could benefit from exergames in VR. The requirements in older CBP patients for a VR pain therapy have not yet been determined in studies. The aim of the study was to perform a requirements analysis for the user group of geriatric patients with CBP for a VR exergame. The objective was to find out the expectations, desires, preferences and barriers in order to collect them as requirements for this vulnerable group and to determine frameworks of therapy by physiotherapists and psychotherapists. METHODS We conducted a requirements analysis through semi-structured interviews with 10 elderly participants with CBP. Furthermore, two focus groups were conducted with three physiotherapists and two psychotherapists to determine frameworks of therapy programs for the target group. The qualitative data were transcribed and examined through a structuring content analysis. Subsequently, the results of the analysis were prioritized by all participants of the study. RESULTS The results of the requirements analysis indicate mandatory requirements for the overall system, hardware, software and gamification elements. The key requirements were target-group-specific applications of the VR exergame through e.g. individual briefing, user-friendly handling, inclusion of movement limitations, presentation of everyday scenarios in combination with biofeedback, age-appropriate feedback through praise and awards and a maximum exercise duration of 30 min and 15 min of relaxation. CONCLUSION It should be possible to use the determined requirements productively to create user-friendly VR exergames that motivate elderly chronic back pain patients to perform exercises regularly. TRIAL REGISTRATION The study is registered in the German Clinical Trials Register (DRKS-ID: DRKS00015294 12.10.2018).
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Affiliation(s)
- Oskar Stamm
- Geriatrics Research Group - Age and Technology Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Reinickendorfer Strasse 61, 13347, Berlin, Germany.
| | - Rebecca Dahms
- Geriatrics Research Group - Age and Technology Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Reinickendorfer Strasse 61, 13347, Berlin, Germany
| | - Ursula Müller-Werdan
- Geriatrics Research Group - Age and Technology Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Reinickendorfer Strasse 61, 13347, Berlin, Germany
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Michels G, Sieber CC, Marx G, Roller-Wirnsberger R, Joannidis M, Müller-Werdan U, Müllges W, Gahn G, Pfister R, Thürmann PA, Wirth R, Fresenborg J, Kuntz L, Simon ST, Janssens U, Heppner HJ. [Geriatric intensive care : Consensus paper of DGIIN, DIVI, DGAI, DGGG, ÖGGG, ÖGIAIN, DGP, DGEM, DGD, DGNI, DGIM, DGKliPha and DGG]. Med Klin Intensivmed Notfmed 2020; 115:393-411. [PMID: 31278437 DOI: 10.1007/s00063-019-0590-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The proportion of elderly, frail, and multimorbid people has increased dramatically in recent decades resulting from demographic changes and will further increase, which will impact acute medical care. Prospective, randomized studies on geriatric intensive care are still lacking. There are also no international or national recommendations regarding the management of critically ill elderly patients. Based on an expert opinion, this consensus paper provides 16 statements that should be considered when dealing with geriatric critical care patients.
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Affiliation(s)
- Guido Michels
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Cornel C Sieber
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
| | - Gernot Marx
- Klinik für Operative Intensivmedizin und Intermediate Care, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland
| | | | - Michael Joannidis
- Gemeinsame Einrichtung für Internistische Intensiv- und Notfallmedizin, Department Innere Medizin, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Ursula Müller-Werdan
- Klinik für Geriatrie und Altersmedizin, Evangelisches Geriatriezentrum Berlin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Wolfgang Müllges
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Georg Gahn
- Neurologische Klinik, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Deutschland
| | - Roman Pfister
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Petra A Thürmann
- Lehrstuhl für Klinische Pharmakologie, Helios Universitätsklinkum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
| | - Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - Jana Fresenborg
- Seminar für Allgemeine BWL und Management im Gesundheitswesen, Universität zu Köln, Köln, Deutschland
| | - Ludwig Kuntz
- Seminar für Allgemeine BWL und Management im Gesundheitswesen, Universität zu Köln, Köln, Deutschland
| | - Steffen T Simon
- Zentrum für Palliativmedizin, Uniklinik Köln, Köln, Deutschland
| | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital Eschweiler, Eschweiler, Deutschland
| | - Hans Jürgen Heppner
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
- Geriatrische Klinik und Tagesklinik, Lehrstuhl für Geriatrie, HELIOS Klinikum Schwelm, Universität Witten/Herdecke, Schwelm, Deutschland
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Raeder K, Jachan DE, Müller-Werdan U, Lahmann NA. Prevalence and risk factors of chronic wounds in nursing homes in Germany: A Cross-Sectional Study. Int Wound J 2020; 17:1128-1134. [PMID: 32815303 PMCID: PMC7949346 DOI: 10.1111/iwj.13486] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 12/28/2022] Open
Abstract
The burdens caused by chronic wounds on the affected persons themselves and also on the health care system are well recognised. The aim of this study was to investigate the prevalence and risk factors of chronic wounds in German nursing homes. An annual cross-sectional study was conducted in nursing home residents from 2012 to 2018. The proportion of men affected by chronic wounds was to some extent higher than that of women, 9.0% males vs 7.5% females. In total, 7.8% of all residents were affected by chronic wounds. Of all residents with a chronic wound, 50.5% were affected by pressure ulcer. Male residents were twice as often affected by diabetic foot ulcer than female residents (18.0% vs 8.9%; P = 0.002). Bivariate analysis showed that chronic wounds were highly associated with poor nutrition, urinary incontinence, stool incontinence, diabetes mellitus, and limited mobility (P = 0.000). According to multivariate analysis, the strongest predictors for chronic wounds were limited mobility and diabetes mellitus. The highest prevalence of chronic wounds was in residents who were not restricted in their mobility, had diabetes, were male, and lived in a metropolitan region (23.7%). This study identified the prevalence and risk factors of chronic wounds in nursing home residents. Further research is needed to identify causal factors of the gender difference in the prevalence of chronic wounds. This may have an impact on the choice of prophylactic and therapeutic measures.
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Affiliation(s)
- Kathrin Raeder
- Charité - Universitätsmedizin Berlin, Department of Geriatric Medicine, Nursing Research Group in Geriatrics, Berlin, Germany
| | - Deborah Elisabeth Jachan
- Charité - Universitätsmedizin Berlin, Department of Geriatric Medicine, Nursing Research Group in Geriatrics, Berlin, Germany
| | - Ursula Müller-Werdan
- Charité - Universitätsmedizin Berlin, Department of Geriatric Medicine, Nursing Research Group in Geriatrics, Berlin, Germany
| | - Nils Axel Lahmann
- Charité - Universitätsmedizin Berlin, Department of Geriatric Medicine, Nursing Research Group in Geriatrics, Berlin, Germany
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Herpich C, Franz K, Ost M, Otten L, Coleman V, Klaus S, Müller-Werdan U, Norman K. Associations Between Serum GDF15 Concentrations, Muscle Mass, and Strength Show Sex-Specific Differences in Older Hospital Patients. Rejuvenation Res 2020; 24:14-19. [PMID: 32475214 DOI: 10.1089/rej.2020.2308] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aging is accompanied by a progressive decline of muscle mass and strength and also higher levels of circulating cytokines such as growth differentiation factor 15 (GDF15). Studies evaluating the association of GDF15 with muscle mass and strength are rare. In this analysis, we investigated GDF15 concentrations and their relationship with muscle mass and strength in older men compared with women. GDF15 serum concentrations were measured in 103 (60 years and older) hospital patients and an age-matched control group with an immunosorbent assay. Skeletal muscle mass was determined with the bioelectrical impedance analysis. Grip strength and knee extension strength were assessed and normalized for height. Associations between GDF15 concentrations and muscle mass and strength were evaluated with general linear models. Male patients showed higher levels of GDF15 compared with female patients (p = 0.021). Elevated GDF15 concentrations were associated with lower measures of muscle mass, exclusively in men, after adjustment for age and number of drugs per day. Our results indicate sex differences between associations of GDF15 with muscle mass and strength parameters in a cohort of older hospital patients.
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Affiliation(s)
- Catrin Herpich
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Kristina Franz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Working Group Nutrition and Body Composition, Berlin, Germany
| | - Mario Ost
- Department of Physiology and Energy Metabolism, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Lindsey Otten
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Working Group Nutrition and Body Composition, Berlin, Germany
| | - Verena Coleman
- Department of Physiology and Energy Metabolism, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Susanne Klaus
- Department of Physiology and Energy Metabolism, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany.,University of Potsdam, Institute of Nutritional Science, Nuthetal, Germany
| | - Ursula Müller-Werdan
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Working Group Nutrition and Body Composition, Berlin, Germany.,Protestant Geriatric Centre Berlin, Berlin, Germany
| | - Kristina Norman
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany.,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Working Group Nutrition and Body Composition, Berlin, Germany.,University of Potsdam, Institute of Nutritional Science, Nuthetal, Germany
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Werdan K, Müller-Werdan U, Perings S. Die chronische koronare Herzkrankheit/das chronische Koronarsyndrom – Was
sagen die deutschen und die europäischen Leitlinien? Aktuelle Kardiologie 2020. [DOI: 10.1055/a-1179-5728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungVon der Volkskrankheit „koronare Herzkrankheit“ (KHK) ist jeder zehnte 40- bis
79-Jährige in Deutschland betroffen. Basierend auf den Leitlinien der Europäischen
Gesellschaft für Kardiologie zu chronischen Koronarsyndromen (CCS) und zur
Myokardrevaskularisation sowie der Nationalen VersorgungsLeitlinie (NVL) „Chronische
KHK“ werden evidenz- und expertenbasierte Empfehlungen zur Diagnosestellung sowie zur
Behandlung und Betreuung der KHK-/CCS-Patienten dargestellt, mit Fokus auf
nichtinvasive und invasive Myokardischämiediagnostik sowie medikamentöse und
myokardrevaskularisierende Maßnahmen. Voneinander abweichende Empfehlungen der
einzelnen Leitlinien in seltenen Fällen erweitern den Ermessensspielraum des Arztes.
Das Aufzeigen des Notwendigen und Angemessenen sind wesentliche Intentionen dieser
Leitlinien, mit dem Ziel, die Qualität der Patientenversorgung auf bestmöglichem
Niveau zu halten.
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Affiliation(s)
- Karl Werdan
- Universitätsklinik und Poliklinik für Innere Medizin III,
Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle-Wittenberg,
Halle (Saale)
| | - Ursula Müller-Werdan
- Klinik für Geriatrie und Altersmedizin der Charité – Universitätsmedizin
Berlin, und Evangelisches Geriatriezentrum Berlin
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Yürek F, Olbert M, Müller-Werdan U, Held H, Knaak C, Hermes C, Dubb R, Kaltwasser A, Monke S, Spies C. [Perioperative Neurocognitive Disorders - Postoperative Prevention Strategies]. Anasthesiol Intensivmed Notfallmed Schmerzther 2019; 54:669-683. [PMID: 31805586 DOI: 10.1055/a-0853-3116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Postoperative delirium (POD) is a common and serious complication after surgery. It is associated with increased morbidity and mortality as well as neurocognitive disorder and associated loss of autonomy and increased need for care. As professionals, it is our duty to treat our patients in a holistic individual concept with the aim to reintegrate our patients into their home and social environment afterwards. In addition to preoperative and intraoperative interventions, postoperative prevention is of particular importance. This article focuses on non-pharmacological prevention strategies to avoid postoperative delirium and neurocognitive disorder in postoperative inpatient care. It is based on the "Evidence-based and consensus-based guideline on postoperative delirium". Thus, risk factors are addressed and non-pharmacological strategies are presented, which include reorientation, mobilization and nutritional support. Interprofessional cooperation plays just as important a role as the implementation of the listed preventive measures. Finally, the modified Hospital Elder Life Program is presented, which presents and applies preventive measures as a system-oriented and interdisciplinary concept, which "prevents functional decline and allows older adults to return home at the maximal level of independence". From our point of view, the training of a professional delirium team is a future-oriented complementary measure in the treatment concept of Perioperative Neurocognitive Disorders (PND), which finds its justification as an interface in the treatment of high-risk patients.
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Müller-Werdan U. Einführung in den Altersbegriff. Drug Res (Stuttg) 2019; 69:S5. [DOI: 10.1055/a-0982-4993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Müller-Werdan U, Endres S. Editorial. Drug Res (Stuttg) 2019; 69:S4. [DOI: 10.1055/a-0982-4982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Franz K, Otten L, Müller-Werdan U, Doehner W, Norman K. Severe Weight Loss and Its Association with Fatigue in Old Patients at Discharge from a Geriatric Hospital. Nutrients 2019; 11:nu11102415. [PMID: 31658676 PMCID: PMC6835926 DOI: 10.3390/nu11102415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 01/02/2023] Open
Abstract
Although malnutrition is frequent in the old, little is known about its association with fatigue. We evaluated the relation of self-reported severe weight loss with fatigue and the predictors for fatigue in old patients at hospital discharge. Severe weight loss was defined according to involuntary weight loss ≥5% in the last three months. We determined fatigue with the validated Brief Fatigue Inventory questionnaire. The regression analyses were adjusted for age, sex, number of comorbidities, medications/day, and BMI. Of 424 patients aged between 61 and 98 y, 34.1% had severe weight loss. Fatigue was higher in patients with severe weight loss (3.7 ± 2.3 vs. 3.2 ± 2.3 points, p = 0.021). In a multinomial regression model, weight loss was independently associated with higher risk for moderate fatigue (OR:1.172, CI:1.026-1.338, p = 0.019) and with increased risk for severe fatigue (OR:1.209, CI:1.047-1.395, p = 0.010) together with the number of medications/day (OR:1.220, CI:1.023-1.455, p = 0.027). In a binary regression model, severe weight loss predicted moderate-to-severe fatigue in the study population (OR:1.651, CI:1.052-2.590, p = 0.029). In summary, patients with self-reported severe weight loss at hospital discharge exhibited higher fatigue levels and severe weight loss was an independent predictor of moderate and severe fatigue, placing these patients at risk for impaired outcome in the post-hospital period.
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Affiliation(s)
- Kristina Franz
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Working Group Nutrition and Body Composition, Reinickendorfer Str. 61, 13347 Berlin, Germany.
- German Institute of Human Nutrition Potsdam - Rehbrücke, Department of Nutrition and Gerontology, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
| | - Lindsey Otten
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Working Group Nutrition and Body Composition, Reinickendorfer Str. 61, 13347 Berlin, Germany.
- German Institute of Human Nutrition Potsdam - Rehbrücke, Department of Nutrition and Gerontology, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
| | - Ursula Müller-Werdan
- Protestant Geriatric Center Berlin, Reinickendorfer Str. 61, 13347 Berlin, Germany.
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Reinickendorfer Str. 61, 13347 Berlin, Germany.
| | - Wolfram Doehner
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, BCRT-Berlin Institute of Health Centre for Regenerative Therapies, Föhrer Str. 15, 13353 Berlin, Germany.
- DZHK-German Centre for Cardiovascular Research, Partner Site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany.
| | - Kristina Norman
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Working Group Nutrition and Body Composition, Reinickendorfer Str. 61, 13347 Berlin, Germany.
- German Institute of Human Nutrition Potsdam - Rehbrücke, Department of Nutrition and Gerontology, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
- University of Potsdam, Institute of Nutritional Science, Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
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Michels G, Müller-Werdan U. [Intensive Care in Elderly Patients - Consideration of Age-Related Organ Dysfunction and Vulnerability]. Dtsch Med Wochenschr 2019; 144:1411-1416. [PMID: 31594015 DOI: 10.1055/a-0646-7910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The physiology of aging must be understood first in order to detect pathophysiological deviations early on and to interact accordingly. To date, there exist no guidelines or recommendations, nor randomized controlled trials in the field of geriatric intensive care. The mortality of elderly ICU patients is not determined solely by age, but by the age-physiological decrease of the functional reserves and the age-related vulnerability factors.
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Affiliation(s)
- Guido Michels
- Klinik III für Innere Medizin, Herzzentrum, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Köln
| | - Ursula Müller-Werdan
- Klinik für Geriatrie und Altersmedizin der Charité - Universitätsmedizin Berlin und Evangelisches Geriatriezentrum Berlin, Berlin
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Leistner DM, Bazara S, Münch C, Steiner J, Erbay A, Siegrist PT, Skurk C, Lauten A, Müller-Werdan U, Landmesser U, Stähli BE. Association of the body mass index with outcomes in elderly patients (≥80 years) undergoing percutaneous coronary intervention. Int J Cardiol 2019; 292:73-77. [DOI: 10.1016/j.ijcard.2019.06.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/30/2019] [Accepted: 06/18/2019] [Indexed: 01/10/2023]
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Nave AH, Rackoll T, Grittner U, Bläsing H, Gorsler A, Nabavi DG, Audebert HJ, Klostermann F, Müller-Werdan U, Steinhagen-Thiessen E, Meisel A, Endres M, Hesse S, Ebinger M, Flöel A. Physical Fitness Training in Patients with Subacute Stroke (PHYS-STROKE): multicentre, randomised controlled, endpoint blinded trial. BMJ 2019; 366:l5101. [PMID: 31533934 PMCID: PMC6749174 DOI: 10.1136/bmj.l5101] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the safety and efficacy of aerobic exercise on activities of daily living in the subacute phase after stroke. DESIGN Multicentre, randomised controlled, endpoint blinded trial. SETTING Seven inpatient rehabilitation sites in Germany (2013-17). PARTICIPANTS 200 adults with subacute stroke (days 5-45 after stroke) with a median National Institutes of Health stroke scale (NIHSS, range 0-42 points, higher values indicating more severe strokes) score of 8 (interquartile range 5-12) were randomly assigned (1:1) to aerobic physical fitness training (n=105) or relaxation sessions (n=95, control group) in addition to standard care. INTERVENTION Participants received either aerobic, bodyweight supported, treadmill based physical fitness training or relaxation sessions, each for 25 minutes, five times weekly for four weeks, in addition to standard rehabilitation therapy. Investigators and endpoint assessors were masked to treatment assignment. MAIN OUTCOME MEASURES The primary outcomes were change in maximal walking speed (m/s) in the 10 m walking test and change in Barthel index scores (range 0-100 points, higher scores indicating less disability) three months after stroke compared with baseline. Safety outcomes were recurrent cardiovascular events, including stroke, hospital readmissions, and death within three months after stroke. Efficacy was tested with analysis of covariance for each primary outcome in the full analysis set. Multiple imputation was used to account for missing values. RESULTS Compared with relaxation, aerobic physical fitness training did not result in a significantly higher mean change in maximal walking speed (adjusted treatment effect 0.1 m/s (95% confidence interval 0.0 to 0.2 m/s), P=0.23) or mean change in Barthel index score (0 (-5 to 5), P=0.99) at three months after stroke. A higher rate of serious adverse events was observed in the aerobic group compared with relaxation group (incidence rate ratio 1.81, 95% confidence interval 0.97 to 3.36). CONCLUSIONS Among moderately to severely affected adults with subacute stroke, aerobic bodyweight supported, treadmill based physical fitness training was not superior to relaxation sessions for maximal walking speed and Barthel index score but did suggest higher rates of adverse events. These results do not appear to support the use of aerobic bodyweight supported fitness training in people with subacute stroke to improve activities of daily living or maximal walking speed and should be considered in future guidelines. TRIAL REGISTRATION ClinicalTrials.gov NCT01953549.
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Affiliation(s)
- Alexander H Nave
- Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research, partner site Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Torsten Rackoll
- Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Kliniken Beelitz, Beelitz-Heilstätten, Germany
| | - Ulrike Grittner
- Berlin Institute of Health, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Darius G Nabavi
- Vivantes Klinikum Neukölln, Klinik für Neurologie, Berlin, Germany
| | - Heinrich J Audebert
- Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Klostermann
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Andreas Meisel
- Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Endres
- Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research, partner site Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases, partner site Berlin, Germany
| | - Stefan Hesse
- Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Martin Ebinger
- Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Agnes Flöel
- Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
- German Center for Neurodegenerative Diseases, partner site Rostock/Greifswald, Germany
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Otten L, Stobäus N, Franz K, Genton L, Müller-Werdan U, Wirth R, Norman K. Impact of sarcopenia on 1-year mortality in older patients with cancer. Age Ageing 2019; 48:413-418. [PMID: 30608508 DOI: 10.1093/ageing/afy212] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/25/2018] [Accepted: 12/14/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES sarcopenia is common especially in hospitalised older populations. The aim of this study was to assess the prevalence of sarcopenia, defined as low skeletal mass and muscle strength, and its impact on 1-year mortality in older patients with cancer. METHODS skeletal muscle mass was estimated using bioelectric impedance analysis and related to height2 (SMI; Janssen et al. 2002). Grip strength was measured with the JAMAR dynamometer and the cut-offs suggested by the European Working Group on Sarcopenia in Older People (EWGSOP) were applied. One-year mortality was assessed by telephone follow-up and the local cancer death registry. RESULTS of the 439 consecutively recruited cancer patients (60-95 years; 43.5% women), 119 (27.1%) had sarcopenia. Of the patients with sarcopenia, 62 (52.5%) died within 1 year after study entry compared to 108 (35.1%) patients who did not have sarcopenia (P = 0.001). In a stepwise, forward Cox proportional hazards analysis, sarcopenia (HR = 1.53; 95% CI: 1.034-2.250; P < 0.05), advanced disease (HR = 1.87; 95% CI: 1.228-2.847; P < 0.05), number of drugs/day (HR = 1.11; 95% CI: 1.057-1.170; P < 0.001), tumour diagnosis (overall P < 0.05) and Karnofsky index (HR = 0.98, 95% CI: 0.963-0.995; P < 0.05) associated with 1-year mortality risk. The factors sex, age, co-morbidities and involuntary 6-month weight loss ≥5% were insignificant. CONCLUSIONS sarcopenia was present in 27.1% of older patients with cancer and was independently associated with 1-year mortality. The fact that sarcopenia was nearly as predictive for 1-year mortality as an advanced disease stage underlines the importance of preservation of muscle mass and function as a potential target of intervention in older patients with cancer.
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Affiliation(s)
- Lindsey Otten
- Charité—Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Geriatrics, Research Group Geriatrics, Berlin, Germany
| | - Nicole Stobäus
- Charité—Universitätsmedizin Berlin, Campus Mitte, Berlin Institute of Health, Clinical Research Unit, Germany
| | - Kristina Franz
- Charité—Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Geriatrics, Research Group Geriatrics, Berlin, Germany
| | - Laurence Genton
- Geneva University Hospitals, Clinical Nutrition, Geneva, Switzerland
| | - Ursula Müller-Werdan
- Charité—Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Geriatrics, Research Group Geriatrics, Berlin, Germany
| | - Rainer Wirth
- Marien Hospital Herne, University Hospital Ruhr-Universität Bochum, Germany
| | - Kristina Norman
- Charité—Universitätsmedizin Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Geriatrics, Research Group Geriatrics, Berlin, Germany
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
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Raeder K, Strube-Lahmann S, Müller-Werdan U, Kottner J, Lahmann NA, Suhr R. [Prevalence and influencing factors of chronic wounds among clients of home care services in Germany]. Z Evid Fortbild Qual Gesundhwes 2019; 140:14-21. [PMID: 30777680 DOI: 10.1016/j.zefq.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/13/2019] [Accepted: 01/18/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Chronic or non-healing wounds are a serious problem for both the parties involved and the healthcare system. Currently, there are hardly any reliable data on the prevalence of chronic wounds in outpatient care, although this setting is becoming increasingly important. Therefore, the aim of this study was to determine the prevalence of and the factors associated with chronic wounds in clients cared for by home care services. METHOD As part of a cross-sectional study throughout Germany in 2012, a survey was conducted among care recipients provided by home care services. The sample was drawn in a two-step procedure. First, a random sample of home care services was drawn for each federal state, followed by random selection of clients to be interviewed for each service. The aim of the study was to describe the prevalence of chronic wounds and influencing factors such as BMI, age, housing situation, activity and diabetes mellitus. Data collection through questionnaire was carried out by trained nurses. RESULTS A total of 144 home care services with 1,296 clients had agreed to participate. With 880 care recipients from 100 home care services finally taking part in the survey, the response rate was 68 %. Of all care recipients examined, 101 had at least one chronic wound; the highest prevalence rates were observed for pressure ulcers (4.6 %) and leg ulcers (4.0 %). Care recipients with diabetes mellitus were more frequently affected by chronic wounds (16.4 %) than non-diabetic recipients (9.5 %). Community-living care recipients (14.1 % chronic wounds; 6.0 % pressure ulcers) and care recipients under the age of 65 (20 % chronic wounds; 9.5 % pressure ulcers) were affected more frequently than care recipients living alone (9.1 % chronic wounds; 3.0 % pressure ulcers) or care recipients older than 65 years (10.5 % chronic wounds; 4.0 % pressure ulcers). In the multivariate calculation, the BMI proved to be the strongest predictor. The prevalence of chronic wounds in the group of obese (BMI>35.3kg/m2) care recipients and those with activity restriction is 44.8 %. CONCLUSION In view of the fact that one out of nine care recipients receiving assistance from home care services is affected by at least one non-healing wound, special attention should be paid to the prevention, detection and treatment of chronic wounds. Furthermore, it seems particularly necessary to identify the relevant risk groups in order to be able to initiate adequate and preventive measures at an early stage.
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Affiliation(s)
- Kathrin Raeder
- Charité - Universitätsmedizin Berlin I Klinik für Geriatrie und Altersmedizin I Forschungsgruppe Geriatrie I AG - Pflegeforschung,Berlin, Deutschland.
| | - Sandra Strube-Lahmann
- Charité - Universitätsmedizin Berlin I Klinik für Geriatrie und Altersmedizin I Forschungsgruppe Geriatrie I AG - Pflegeforschung,Berlin, Deutschland
| | - Ursula Müller-Werdan
- Charité - Universitätsmedizin Berlin I Klinik für Geriatrie und Altersmedizin,Berlin, Deutschland
| | - Jan Kottner
- Charité - Universitätsmedizin Berlin | Klinik für Dermatologie, Venerologie und Allergologie, Clinical Research Center for Hair and Skin Science, Berlin, Deutschland
| | - Nils A Lahmann
- Charité - Universitätsmedizin Berlin I Klinik für Geriatrie und Altersmedizin I Forschungsgruppe Geriatrie I AG - Pflegeforschung,Berlin, Deutschland
| | - Ralf Suhr
- Zentrum für Qualität in der Pflege (ZQP), Berlin, Deutschland
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Fürstenau D, Spies C, Gersch M, Vogel A, Mörgeli R, Poncette AS, Müller-Werdan U, Balzer F. Sharing Frailty-related information in perioperative care: an analysis from a temporal perspective. BMC Health Serv Res 2019; 19:105. [PMID: 30732604 PMCID: PMC6367783 DOI: 10.1186/s12913-019-3890-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 01/08/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Especially patients older than 65 years undergoing surgery are prone to develop frailty-related complications that may go far beyond the index hospitalization (e.g., cognitive impairment following postoperative delirium). However, aging-relevant information are currently not fully integrated into hospitals' perioperative processes. METHODS We introduce a temporal perspective, which focuses on the social construction of time, to better understand existing barriers to the exchange of frailty-related data, targeting complexity research. Our chosen context is perioperative care provided by a tertiary hospital in Germany that has implemented a special track for patients over 65 years old undergoing elective surgery. The research followed a participatory modelling approach between domain and modelling experts with the goal of creating a feedback loop model of the relevant system relationships and dynamics. RESULTS The results of the study show how disparate temporal regimes, understood as frameworks for organizing actions in the light of time constraints, time pressure, and deadlines, across different clinical, ambulant, and geriatric care sectors create disincentives to cooperate in frailty-related data exchanges. Moreover, we find that shifting baselines, meaning continuous increases in cost and time pressure in individual sectors, may unintentionally reinforce - rather than discourage - disparate temporal regimes. CONCLUSIONS Together, these results may (1) help to increase awareness of the importance of frailty-related data exchanges, and (2) impel efforts aiming to transform treatment processes to go beyond sectoral boundaries, taking into account the potential benefits for frail patients arising from integrated care processes using information technology.
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Affiliation(s)
- Daniel Fürstenau
- Department of Information Systems, Freie Universität Berlin, School of Business & Economics, Garystr. 21, 14195, Berlin, Germany.,Einstein Center Digital Future, Wilhelmstraße 67, 10117, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Gersch
- Department of Information Systems, Freie Universität Berlin, School of Business & Economics, Garystr. 21, 14195, Berlin, Germany
| | - Amyn Vogel
- Department of Information Systems, Freie Universität Berlin, School of Business & Economics, Garystr. 21, 14195, Berlin, Germany
| | - Rudolf Mörgeli
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Akira-Sebastian Poncette
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Einstein Center Digital Future, Wilhelmstraße 67, 10117, Berlin, Germany
| | - Ursula Müller-Werdan
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Geriatric Research Group, Reinickendorfer Str. 61, 13347, Berlin, Germany
| | - Felix Balzer
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Einstein Center Digital Future, Wilhelmstraße 67, 10117, Berlin, Germany.
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Krobisch V, Deutschbein J, Möckel M, Schmiedhofer M, Schneider A, Inhoff T, Keil T, Heintze C, Rose M, Müller-Werdan U, Schenk L. [Erratum to: Empirical health services research in emergency and acute medicine : Preliminary results of concomitantmonitoring of patient recruitment and sample quality]. Med Klin Intensivmed Notfmed 2019; 115:134. [PMID: 30673823 DOI: 10.1007/s00063-019-0536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- V Krobisch
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - J Deutschbein
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland
| | - M Möckel
- Notfall- und Akutmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - M Schmiedhofer
- Notfall- und Akutmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - A Schneider
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland
| | - T Inhoff
- Notfall- und Akutmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - T Keil
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - C Heintze
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - M Rose
- Medizinische Klinik mit Schwerpunkt Psychosomatik, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - U Müller-Werdan
- Klinik für Geriatrie und Altersmedizin der Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, und Evangelisches Geriatriezentrum Berlin, Berlin, Deutschland
| | - L Schenk
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland
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Krobisch V, Deutschbein J, Möckel M, Schmiedhofer M, Schneider A, Inhoff T, Keil T, Heintze C, Rose M, Müller-Werdan U, Schenk L. [Empirical health services research in emergency and acute medicine : Preliminary results of concomitant monitoring of patient recruitment and sample quality]. Med Klin Intensivmed Notfmed 2019; 115:125-133. [PMID: 30603954 DOI: 10.1007/s00063-018-0522-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/22/2018] [Accepted: 11/09/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Up until now, research data on the implementation of empirical health services research in emergency departments in Germany are scarce. STUDY AIM A monitoring instrument applied in a multicenter prospective cohort study in emergency departments (EDs) is described and discussed regarding requirements for the control and supervision of data collection. MATERIALS AND METHODS Patients with cardiac diseases, respiratory tract infections, and hip fractures were recruited in eight EDs located in a central district of Berlin. Enrolment figures and nonresponder reasons were analyzed through descriptive statistics. Potential sample bias was examined in terms of response rates as well as the distribution of age and sex in the group of participants and nonresponders. Qualitative content analysis was applied to data from routine supervisory and feedback meetings with study nurses. RESULTS Within the first 8 months of data collection, 61.1% of the aimed 1104 patients were recruited. Most frequently stated nonresponder reasons were the dense work and care processes in EDs (41.9%) and patients' disease burden (24.7%). Moreover, qualitative results revealed problems with identifying potentially eligible participants and difficulties because of missing research infrastructure in study centers. The response rate of 50.7% and approximately equal distribution of age and sex in participants and nonresponders do not indicate sample biases. DISCUSSION The monitoring instrument has proven to be suited for empirical research in EDs and revealed optimization potential. We recommend using qualitative and quantitative data systematically.
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Affiliation(s)
- V Krobisch
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland.
| | - J Deutschbein
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - M Möckel
- Notfall- und Akutmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - M Schmiedhofer
- Notfall- und Akutmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - A Schneider
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - T Inhoff
- Notfall- und Akutmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - T Keil
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - C Heintze
- Institut für Allgemeinmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - M Rose
- Medizinische Klinik mit Schwerpunkt Psychosomatik, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - U Müller-Werdan
- Klinik für Geriatrie und Altersmedizin der Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, und Evangelisches Geriatriezentrum Berlin, Berlin, Deutschland
| | - L Schenk
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
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Franz K, Ost M, Otten L, Herpich C, Coleman V, Endres AS, Klaus S, Müller-Werdan U, Norman K. Higher serum levels of fibroblast growth factor 21 in old patients with cachexia. Nutrition 2018; 63-64:81-86. [PMID: 30933730 DOI: 10.1016/j.nut.2018.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/14/2018] [Accepted: 11/17/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Fibroblast growth factor (FGF)21 is promptly induced by short fasting in animal models to regulate glucose and fat metabolism. Data on FGF21 in humans are inconsistent and FGF21 has not yet been investigated in old patients with cachexia, a complex syndrome characterized by inflammation and weight loss. The aim of this study was to explore the association of FGF21 with cachexia in old patients compared with their healthy counterparts. METHODS Serum FGF21 and its inactivating enzyme fibroblast activation protein (FAP)-α were measured with enzyme-linked immunoassays. Cachexia was defined as ≥5% weight loss in the previous 3 mo and concurrent anorexia (Council on Nutrition appetite questionnaire). RESULTS We included 103 patients with and without cachexia (76.9 ± 5.2 y of age) and 56 healthy controls (72.9 ± 5.9 y of age). Cachexia was present in 16.5% of patients. These patients had significantly higher total FGF21 levels than controls (952.1 ± 821.3 versus 525.2 ± 560.3 pg/mL; P = 0.012) and the lowest FGF21 levels (293.3 ± 150.9 pg/mL) were found in the control group (global P < 0.001). Although FAP-α did not differ between the three groups (global P = 0.082), bioactive FGF21 was significantly higher in patients with cachexia (global P = 0.002). Risk factor-adjusted regression analyses revealed a significant association between cachexia and total (β = 649.745 pg/mL; P < 0.001) and bioactive FGF21 (β = 393.200 pg/mL; P <0.001), independent of sex, age, and body mass index. CONCLUSIONS Patients with cachexia exhibited the highest FGF21 levels. Clarification is needed to determine whether this is an adaptive response to nutrient deprivation in disease-related cachexia or whether the increased FGF21 values contribute to the catabolic state.
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Affiliation(s)
- Kristina Franz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Working Group Nutrition and Body Composition, Berlin, Germany
| | - Mario Ost
- German Institute of Human Nutrition Potsdam - Rehbrücke, Department of Physiology and Energy Metabolism, Nuthetal, Germany
| | - Lindsey Otten
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Working Group Nutrition and Body Composition, Berlin, Germany
| | - Catrin Herpich
- German Institute of Human Nutrition Potsdam - Rehbrücke, Department of Nutrition and Gerontology, Nuthetal, Germany
| | - Verena Coleman
- German Institute of Human Nutrition Potsdam - Rehbrücke, Department of Physiology and Energy Metabolism, Nuthetal, Germany
| | - Anne-Sophie Endres
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Berlin, Germany; Protestant Geriatric Center Berlin, Berlin, Germany
| | - Susanne Klaus
- German Institute of Human Nutrition Potsdam - Rehbrücke, Department of Physiology and Energy Metabolism, Nuthetal, Germany; University of Potsdam, Institute of Nutritional Science, Nuthetal, Germany
| | - Ursula Müller-Werdan
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Berlin, Germany; Protestant Geriatric Center Berlin, Berlin, Germany
| | - Kristina Norman
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Institute of Health, Research Group on Geriatrics, Working Group Nutrition and Body Composition, Berlin, Germany; German Institute of Human Nutrition Potsdam - Rehbrücke, Department of Nutrition and Gerontology, Nuthetal, Germany; University of Potsdam, Institute of Nutritional Science, Nuthetal, Germany.
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Affiliation(s)
- A Steinert
- Geriatrics Research Group, Charité - Universitätmedizin Berlin
| | - A Latendorf
- Geriatrics Reserach Group, Charite - Universitätsmedizin Berlin
| | | | - U Müller-Werdan
- Geriatrics Research Group, Charité - Universitätmedizin Berlin
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